Serratus Anterior Plane Block Research Articles

Comparison of deep and combined serratus anterior plane block after video-assisted thoracoscopic surgery; a prospective randomized trial

Aim: Ultrasound-guided plane blocks have been employed frequently in Video-assisted thoracoscopic surgery (VATS). The aim of this study was to evaluate the effect of deep and combined serratus anterior plane block (SAPB) after VATS.Material and Method: The patients, in the age range of 18 to 65 years, with the American Society of Anesthesiologists (ASA) physical status of I-III, and body mass index (BMI) of 18-30 kg/m2, and undergoing lung resection with VATS were included in the study. Patients were informed about the study, and their written consent was obtained. Patients were divided into Deep SAPB (DSAPB) (Group 1) and combined SAPB (CSAPB) (Group 2) groups according to the analgesia protocol.Results: There was no statistically significant difference between the groups in terms of demographic characteristics and surgical features (p>0.05). When the groups were evaluated in terms of the block performance time, it was found to be statistically significantly longer in the CSAPB group than in the DSAPB group (p<0.001). When the groups were evaluated in terms of VAS resting scores, the 1st, 2nd, 4th, 8th, 16th, 24th, and 48th-hour VAS resting results were found to be statistically significantly higher in the DSAPB group than the CSAPB group (p<0.05). VAS cough scores were statistically significantly higher in the DSAPB group at the 1st, 2nd, 4th, 8th, 16th, 24th, and 48th-hour (p<0.05). When the groups were evaluated in terms of the side effects, additional analgesic use, and morphine consumption, they were found to be statistically significantly higher in the DSAPB group than in the CSAPB group (p: 0.026, p: 0.020, p<0.001, respectively).Conclusion: CSAPB provided effective analgesia after VATS for 48 hours. In addition, morphine consumption and the need for additional analgesics were low in CSAPB. However, the duration of the block procedure was longer in the CSAPB application.

Efficacy of ultrasound-guided second serratus anterior plane block on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: a randomized, triple-blind, placebo-controlled study.

Despite widespread application of minimally invasive video-assisted thoracic surgery (VATS), postoperative pain following this procedure is still a constant clinical challenge. Serratus anterior plane (SAP) block is one of the regional analgesic techniques with promising outcomes. However, due to the limited duration of action, optimal analgesia is often not achieved with a single injection. We tested whether in patients who have been subjected to routine SAP block under preoperative anesthesia, the addition of a second SAP block 24 hours after surgery, improves quality of recovery, lowers postoperative opioid consumption, and reduces the prevalence of chronic pain. The present study is a single institutional, prospective, randomized, triple-blinded, placebo-controlled study. Ninety patients undergoing VATS from January 2022 to April 2022 were randomized at 1:1 ratio to receive ultrasound-guided second SAP block with 15 mL 0.375% ropivacaine (SAP block group) or 15 mL normal saline (control group) 24 hours after both groups received routine SAP block with 15 mL 0.375% ropivacaine. The primary outcome was quality of patient recovery, measured using 40-item quality of recovery questionnaire (QoR-40) at postoperative day 2 (POD 2). Secondary outcomes included: postoperative pain scores at rest, postoperative opioid consumptions, number of times that patient controlled analgesia (PCA) pump button was pressed, perioperative complications and adverse effects, prevalence of chronic pain at 2nd and 3rd month postoperatively, and length of hospital stay (LOS). A total of 83 patients completed the study: 43 patients in SAP block group and 40 patients in the control group. The global QoR-40 scores on POD 2 and POD 3 were significantly higher among SAP block group patients (180.07±11.34, 182.09±8.20) compared with the control group (172.18±6.15, 177.50±6.94) (P=0.01, P=0.008) respectively. Postoperative pain scores, opioid consumptions and incidence of postoperative nausea and vomiting were significantly lower among patients in SAP block group versus control group. There were no statistically significant differences in perioperative complications and LOS between the two groups. The prevalence of chronic pain at the 2nd and 3rd month postoperatively for patients in SAP block group and control group was 16.3%, 14%, and 32.5%, 27.5% respectively. In patients undergoing VATS, application of ultrasound-guided second SAP block 24 hours after surgery improved postoperative quality of life, reduced opioid consumption and related side effects, and lowered the prevalence of chronic pain.

Prospective comparative analysis of intraoperative and postoperative anesthetic and analgesic effect of ultrasound-guided pectoral with serratus anterior plane block versus thoracic paravertebral versus erector spinae blocks in breast oncosurgeries

Abstract Aims and Objectives: Different regional anesthetic techniques have been described and are frequently used in breast cancer surgeries to provide efficient pain management and reduce the use of opioids. This study’s main goal was to use pain scores to compare the postoperative analgesic effectiveness of pectoral nerve (PECS 1) block with serratus anterior plane (SAP) block, thoracic paravertebral (TPV) block, and erector spinae plane (ESP) block. Comparing the needs for intraoperative analgesia and postoperative anesthesia was one of the secondary goals. Methods: After institutional ethical committee approval and after prospectively registering this trial with the Clinical Trials Registry of India, 25 patients were randomized and enrolled in each group (Group 1 – PECS 1 and SAP block, Group 2 – TPV group, and Group 3 – ESP group). Standard general anesthesia was administered to all the patients and the blocks, as per randomization were performed before anesthesia induction. Results: The demographic characteristics, intraoperative opioid and sevoflurane consumption, and requirement of rescue analgesia were comparable between the three groups. Pain scores at 0 and 6 h were significantly less in the TPV group when compared to the ESP group and PECS 1 with the SAP group (P = 0.005 and P = 0.006, respectively). Pain scores at 12 and 24 h were comparable between three groups. Conclusion: TPV block provides significantly better pain scores at 0 and 6 h, with comparable pain scores at 12 and 24 h, compared to PECS 1 with SAP block and ESP block with comparable adverse events.

Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis.

The objective of this study was to compare the efficacy and safety of serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) in thoracic region surgery. We implemented a systematic search of PubMed, ScienceDirect, SCOPUS, and Web of Science and through gray literature for all randomized controlled trials that compared SAPB, a novel thoracic wall nerve block, and TEA in surgery. The evaluated outcomes included the Visual Analog Scale (VAS), hypotension, and postoperative nausea and vomiting (PONV). Review Manager, version 5.4.1, was implemented for the analysis of statistics. The pooled analysis included six trials that fulfilled the inclusion criteria. In total 384, surgery had received regional blocks (162 - SAPB and 163 - TEA). VAS did not differ significantly between SAPB and TEA, with a mean difference of 0.71, P = 0.08. PONV incidence did not differ significantly between SAPB and TEA (odds ratio = 0.25, P = 0.07). Hypotension incidence was lower in SAPB compared to TEA (odds ratio = 0.10, P = 0.0001). SAPB yielded comparable VAS with TEA in pain management of thoracic region surgery. The incidence of hypotension was lower in SAPB than in TEA. No difference in PONV incidence was observed. SAPB can be a viable alternative to TEA in thoracic region surgery.

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis.

Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and intercostal nerve block (ICNB) are alternative treatments. Network meta-analysis based on Bayesian analyses was performed to obtain results for direct comparison, indirect comparison, and network comparison, and to make rankings based on probabilities. Covariates were adjusted to determine the effect of the covariates on results of this study. The study identified 61 randomized controlled trials (RCTs) (4468 patients). There were results of probability ranking for the first ("best" treatment): 24 h morphine consumption, TPVB > ESPB > ICNB > SAPB. Covariate adjustment allowed the four treatments to change somewhat in the likelihood of the best choice. TPVB ranks best in our analysis. ESPB is a viable alternative. SAPB and ICNB seem to play a limited role in postoperative pain management.

Comparitive research between ultrasound guided thoracic para vertebral block, serratus anterior plane block and thoracic erector spinae plane block for post-operative pain relief after thoracotomy

Background: Many analgesic modalities have been suggested for management of thoracotomy pain such as peripheral nerve blocks. The purpose of this work was to compare between the post-operative analgesic effect of thoracic paravertebral block (PVB), serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in cases undergoing thoracotomy.Methods: This prospective randomized research was done on 75 adult cases aged 21-60 years scheduled for thoracotomy. Cases were categorized into three equal groups regarding the block had before general anesthesia; PVB group: had ultrasound guided thoracic PVB. SAPB group: had ultrasound guided SAPB. ESPB group: had ultrasound guided ESPB. All cases were monitored for heart rate, mean arterial pressure and pulse oximetry. The following parameters were recorded: postoperative visual analogue score (VAS), quantity of postoperative morphine used after the first dose of emergency analgesic, serum cortisol level and postoperative complications.Results: A significant rise in VAS in group II versus I and III with insignificant difference between I and III. While first time of rescue analgesia was longer in I and III than II with insignificant difference in postoperative complications observed throughout the postoperative period.Conclusions: In cases planned for thoracotomy, the ultrasound-guided technique of performing TPVB and ESPB provide effective intraoperative and prolonged postoperative analgesia versus SAPB as observed by stable hemodynamics and delayed first time of rescue analgesia. Results showed less postoperative morphine dose with superiority toward ESPB regarding simplicity and shorter duration, so it is an effective and safe alternative to TPVB.

A randomized controlled study comparing thoracic paravertebral block to serratus anterior plane block in breast surgery

A randomized controlled study comparing thoracic paravertebral block to serratus anterior plane block in breast surgery

Efficacy of erector spinae plane block versus serratus anterior plane block for perioperative analgesia in lateral thoracotomy surgeries: a randomized controlled trial

Efficacy of erector spinae plane block versus serratus anterior plane block for perioperative analgesia in lateral thoracotomy surgeries: a randomized controlled trial

Retracted: The Anesthetic Effect of Ultrasound-Guided Serratus Anterior Plane Block in Arthroscopic Shoulder Surgery and Its Effect on Postoperative Analgesia.

[This retracts the article DOI: 10.1155/2022/8968805.].

A comparative study of analgesic efficacy of ultrasound-guided serratus anterior plane block versus landmark-guided thoracic paravertebral block for modified radical mastectomy under general anesthesia

A comparative study of analgesic efficacy of ultrasound-guided serratus anterior plane block versus landmark-guided thoracic paravertebral block for modified radical mastectomy under general anesthesia

Ultrasound-guided Serratus Anterior Plane Block, Along with Improved Parasternal Block, is Superior to Serratus Anterior Plane Block Alone in Relieving Pain for Rhinoplasty with Autologous Costal Cartilage.

Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest. Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. RESULTS: Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower (P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished (P < 0.05), and the patient satisfaction was markedly higher (P < 0.001) in the SAPB+PSB group. USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ultrasound-guided serratus anterior plane block versus paravertebral block on postoperation analgesia and safety following the video-assisted thoracic surgery: A prospective, randomized, double-blinded non-inferiority clinical trial

Both the anesthetic efficacy of ultrasound-guided serrate anterior plane block (SAPB) and the ultrasound-guided paravertebral block (PVB) in alleviating postoperative pain have been well concerned. This study primarily aims to evaluate whether the ultrasound-guided SAPB and ultrasound-guided PVB can provide comparable analgesia for video-assisted thoracic surgery. Secondarily, the safety and clinical satisfaction of the two blocks are evaluated. It was a prospective, randomized, double-blinded non-inferiority clinical trial involving 99 patients with lung nodules receiving video-assisted thoracic surgery with ultrasound-guided SAPB or PVB on T4 and T7 vertebra using 0.375% ropivacaine at 3mg/kg. The Visual Analogue Scale (VAS) scores at rest and cough at 24h/48h postoperatively and the incidence and severity of chronic pain at 3 and 6 months postoperatively were the primary outcome. Secondary outcomes included the complications and block application time of two kinds of blocks, and consumption of sufentanil as an analgesic rescue. A total of 92 eligible patients were recruited, including 46 in the SAPB group and 46 in the PVB group. No significant differences in VAS scores at rest and cough at first 48h, 3 months, and 6 months postoperatively between the SAPB group and PVB group were detected (all P>0.05). The SAPB group had fewer complications and higher patient satisfaction(P＜0.05). The ultrasound-guided SAPB was not inferior to PVB in alleviating postoperative pain following the VATS with fewer complications and higher patient satisfaction.

Comparison of the Efficacy of UltrasoundGuided Serratus Anterior Plane Block Versus Erector Spinae Plane Block for Postoperative Analgesia After Modified Radical Mastectomy: A Randomised Controlled Trial.

Several interfascial interfacial plane blocks have been described in patients undergoing modified radical mastectomy. We conducted this study to evaluate the analgesic efficacy of ultrasound-guided serratus anterior plane block and erector spinae plane block in patients undergoing modified radical mastectomy. Totally, 80 female patients (18-70 years) undergoing modified radical mastectomy were randomised into 2 groups of 40 each and were given ultrasound-guided serratus anterior plane block or erector spinae plane block with 0.4 mL kg-1 of 0.375% ropivacaine in this prospective double-blind control trial. The groups were compared for the time to request of first dose of rescue analgesic, requirement of rescue analgesics, and patient satisfaction score. The time to request of the first rescue analgesia was comparable in both groups (P =.056). Postoperative pain scores at rest at 0 minute were significantly lower in serratus anterior plane group as compared to erector spinae plane group (P =.03). The intraoperative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable between the 2 groups. The number of patients requiring rescue doses of fentanyl intraoperatively and rescue analgesics postoperatively was similar in both groups. The mean patient satisfaction score was also comparable in both groups. Ultrasound-guided serratus anterior plane block and erector spinae plane block have comparable postoperative analgesic efficacy after modified radical mastectomy.

Research Progress on Serratus Anterior Plane Block in Breast Surgery: A Narrative Review.

Breast surgery, especially radical mastectomy, is often accompanied by moderate to severe acute pain, which significantly reduces postoperative quality of life. Effective pain management can accelerate patient recovery. Serratus anterior plane block (SAPB) is a new type of fascial plane block technique, which can better target the nerve network innervating the chest wall and breast and provide good analgesia in the anterolateral chest wall. Current clinical research evidence indicates that SAPB has significant benefits in breast surgery. Further research avenues for this technology include optimal local anesthetic dosing strategy, the type of SAPB which is more suitable for breast surgery, comparison of SAPB and pectoral nerve blockII (PECSII) in breast surgery, and high-quality randomized controlled study with outcomes of chronic pain or cancer prognosis.

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

<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.

Dexamethasone as analgesic in different types of gynecologic surgery – A literature review

Background: Dexamethasone is a glucocorticoid and is widely used for postoperative nausea and vomiting (PONV). Recent studies and subsequent guidelines also suggest a role as an analgesic. Dexamethasone as an analgesic has been studied with varying degrees of success in different types of surgery with intravenous doses ranging from 4 mg to 80 mg. The procedure specific postoperative pain management (PROSPECT) guidelines for elective cesarean sections, laparoscopic hysterectomy and oncologic breast surgery all recommend the use of dexamethasone as an analgesic in a multimodal pain regimen, however a particular dose is not mentioned. Objective: To provide a literature review of the use of dexamethasone as an analgesic and at what dosage it has been studied in elective cesarean sections, gynecological laparoscopy and oncologic breast surgery. Methods: The Embase, PubMed, and Cochrane databases were searched for randomized controlled trials published between 2000 and 2021. Results: A total of thirty-four articles were found. Fourteen about elective cesarean section, Thirteen concerning gynecologic laparoscopy and seven regarding oncologic breast surgery. Literature review demonstrated that during elective cesarean section the intravenous (IV) doses ranged from 4 mg to 16 mg. The most investigated IV dose was 8 mg, but overall studies showed conflicting results concerning pain scores and analgesic use. In gynecologic laparoscopy the IV dose ranged from 4 mg to 15mg and again 8 mg was the most frequently studied dose. The IV dose of dexamethasone in oncologic breast surgery ranged from 8 mg to 24 mg. Also in these studies the results were conflicting. In addition, dexamethasone was used as an adjunct to locoregional blocks (perineural use): the transversus abdominis block (TAP) in cesarean section, the serratus anterior plane block (SAP) and the paravertebral block (PVB) in oncologic breast surgery. Conclusion: This literature review provides an overview of the use of dexamethasone in elective cesarean section, gynecologic laparoscopic surgery and oncological breast surgery. Three routes of administration were examined: intravenous, perineural and intraperitoneal. IV 8 mg dexamethasone was the most studied dosage but there were mixed results. Based on this literature review we cannot draw any conclusions regarding the analgesic dose. Further research, with more qualitative RCT’s and systematic reviews with meta-analysis are needed.

Serratus Anterior Plane Block for Clinically Suspected Rib Fractures in Prehospital and Retrieval Medicine

Objective: To describe the use of the serratus anterior plane block (SAPB) in the prehospital and retrieval environment including the ability to accurately identify those patients with thoracic trauma and clinically suspected rib fractures who would benefit from this procedure. Methods: This is a retrospective case series of all patients with thoracic trauma and clinically suspected rib fractures who received SAPB by a prehospital and retrieval medical team in New South Wales, Australia, between 2018 and 2021. The primary outcome was to identify the proportion of patients who received appropriate blocks based on the criteria of reporting moderate pain after receiving adequate pre-block analgesia. Secondary outcomes included the proportions of patients with rib fractures identified on thoracic imaging, concomitant time-critical pathology, radiologist identification of fluid adjacent to the serratus anterior muscle, and local anesthetic systemic toxicity. Results: Of the 2004 patients who sustained thoracic trauma, only 13 received a SAPB. Nine (69.2%) met the predetermined definition of appropriate selection. Of the four patients who did not meet this criteria, three reported less than moderate pain and one did not receive adequate pre-block analgesia. There was no significant effect on median scene interval when compared to other thoracic trauma patients who did not receive a SAPB. Ten patients had rib fractures identified on in-patient imaging (chest x-ray or computed tomography (CT)) with a median (IQR) number of ribs fractured of 5 (interquartile range 2–10). Three of these patients had radiological flail segments. Prespecified time-critical pathology was identified in three patients (23.1%) on initial hospital imaging. Five out of eight patients with post-SAPB CT imaging (62.5%) available for radiologist review had fluid identified adjacent to the serratus anterior muscle. None of the 13 patients had local anesthetic systemic toxicity. Conclusion: The SAPB can be safely and successfully performed in the prehospital and retrieval environment, where clinicians can appropriately identify patients with thoracic trauma and clinically suspected rib fractures who would benefit from this technique. Further research is required to identify the ideal patient population to perform the SAPB upon and compare its performance to current analgesic options.

Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies

ObjectiveSerratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery.MethodsWe systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score.ResultsA total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P &amp;lt; 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P &amp;lt; 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI, 0.27 to 0.42; P &amp;lt; 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P &amp;lt; 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P &amp;lt; 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P &amp;lt; 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P &amp;lt; 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P &amp;lt; 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P &amp;lt; 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months.ConclusionsCompared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioids and shortens the length of hospital stay. SAPB can be used as a feasible technique for multimodal analgesia in the perioperative period.

Comparison of ultrasound-guided serratus anterior plane block and thoracic paravertebral block in postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery.

To compare the effects of ultrasound-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) on postoperative analgesia and inflammation control in patients undergoing upper abdominal surgery. This is a retrospective observational study. The records of patients who underwent upper abdominal surgery in our hospital from June 2019 to January 2021 were selected and retrospectively divided into two groups based on the analgesia method. Fifty-nine patients received ultrasound-guided SAPB analgesia (SAPB-group) and 55 patients received ultrasound-guided TPVB analgesia (TPVB-Group). Patients were matched for age, gender and body-mass index (BMI). The visual analogue scale (VAS) scores of pain at two hours(T1), six hours (T2), 12 hours (T3), 24 hours (T4) and 48 hours (T5) after the operation were compared between the two groups. The levels of interleukin-6 (IL-6), interleukin-10(IL-10) and tumor necrosis factor-α (TNF-α) at the completion of surgery (T0) and T4 were compared between the two groups. The duration of block in SAPB-group was higher than that in TPVB-group (P<0.05). VAS scores of SAPB-groups were significantly lower than those of TPVB-group at all-time points (P<0.05) except at rest 48 hour after the procedure. The levels of IL-6, IL-10 and TNF-α at 24 hours after the operation in both groups were significantly higher than immediately at the end of the operation (P<0.05). Levels of IL-6 and TNF-α 24 hours after the operation were significantly lower in the SAPB-group than in the TPVB-group (P<0.05), while the levels of IL-10 24 hours after the operation were significantly higher in the SAPB-group (P<0.05). SAPB block under ultrasound guidance for patients undergoing upper abdominal surgery has good anesthetic and analgesic effect and can significantly improve the level of postoperative inflammation.

Combined fascial plane blocks as the sole regional anesthesia technique for breast surgery in high-risk patients.

The quest for an effective regional anaesthesia technique in breast surgery has always been eluded by its apparent complexity. Various techniques had been described as anaesthetic techniques for breast cancer surgeries. Fascial plane blocks had been used as analgesic techniques for this procedure. We describe a case series of 12 patients who were given a combination of erector spinae plane block (ESP), Pectoralis I (Pecs I) and serratus anterior plane (SAP) block as sole anaesthetic technique with high risk surgical morbidity. Two patients had discomfort during retraction of axillary apex towards the end of surgery, and one patient had discomfort during medial parasternal incision, which needed a single bolus of low dose ketamine injection. Combined fascial plane blocks could be effectively utilized as a sole regional anesthesia modality for breast cancer surgeries with mild sedation.