SERRATUS ANTERIOR PLANE BLOCK FOR TOTALLY ENDOSCOPIC AORTIC VALVE REPLACEMENT SURGERY: A RANDOMIZED CONTROLLED TRIAL

Abstract

<h3>Objective</h3> Totally endoscopic aortic valve replacement (AVR) has several benefits compared to the classic approach via sternotomy. However, pain after this thoracoscopic intervention is still a problem. The current pain treatment after AVR consists of opioids. Unfortunately, opioids have various side effects, such as nausea, constipation and respiratory depression. These side effects prevent a fast recovery after surgery. Therefore, it is essential to keep postoperative opioid consumption to a minimum. This study aims to investigate the efficacy of the serratus anterior plane (SAP) block in reducing acute postoperative pain after totally endoscopic AVR surgery. During a SAP block, local anaesthetics are injected in the plane beneath the anterior serratus muscle and in the plane between latissimus dorsi and serratus anterior in an ultrasound guided manner. This induces analgesia in dermatomes T2 to T9, which includes the place where surgical incision is realized. In this study, postoperative pain was compared between a treatment with the postoperative SAP block and a treatment without the SAP block. <h3>Design and method</h3> This double-blinded, mono-center, prospective, randomized controlled superiority trial took place in the Jessa Hospital in Hasselt, Belgium. Patients undergoing totally endoscopic AVR were included and randomly allocated to the experimental group, receiving the standard of care plus SAP block, or the control group, receiving normal standard of care. The primary outcome was total opioid (piritramide) consumption during the first 24h after surgery. Secondary outcome measures were physical and mental health measured by the SF-36 questionnaire on postoperative day 2 and length of stay in the ICU and hospital. <h3>Results</h3> Between December 3, 2020 and May 11, 2022, 67 patients were included, of which 62 were analysed. The need for opioid consumption was lower in the experimental group compared to the control group (12 mg [8-26] vs. 19 mg [13.5-30.5], p=0.06). Physical (p=0.70) and mental health (p=0.93) on postoperative day 2 and length of stay in the ICU (p=0.79) and hospital (p=0.84) were similar in both groups. <h3>Conclusions</h3> These preliminary data show a tendency towards reduced opioid consumption when postoperative single-shot serratus anterior plane block is added to routine postoperative care management after thoracoscopic AVR.