Serratus Anterior Plane Block Research Articles

The impact of ultrasound-guided continuous serratus anterior plane block versus intravenous patient-controlled analgesia on the incidence and severity of post-thoracotomy pain syndrome: A randomized, controlled study.

The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane catheter block (SAPB) versus patient-controlled analgesia (PCA) on the emergence of post-thoracotomy pain syndrome (PTPS) after thoracotomies for thoracic tumours. This trial included 89 patients with chest malignancies, scheduled for thoracotomy were randomly allocated into two groups: Group A "PCA-group N=44" receiving patient-controlled analgesia and group B "SAPB group N=45" where analgesia was provided by SAPB. The primary outcome measure was the assessment for the possible emergence of PTPS at 12weeks. The secondary outcome measures were pain relief measured using visual analog scale (VAS) score, Quality of life was assessed using Flanagan Quality of Life Scale (QOLS) and Activity level was assessed using Barthel Activity of daily living (ADL) score. At week 8, PTPS incidence was significantly (p=.037) higher in the PCA group (45%) than in the SAPB group (24%) with a relative risk of 1.38 and 95% CI (1.01-1.9) while the incidence of PTPS at week 12 was significantly (p=.035) higher in the PCA group (43%) than in the SAPB group (22%) with a relative risk of 2.38 and 95% CI (1.23-4.57). The need for pain therapy in PTPS patients was significantly lower in the SAPB group (17.7%) than the PCA group (38.6%) (p=.028) at week 12. Pain intensity: VAS-R and VAS-D (pain scores at rest and with activity, respectively) was comparable (p>.05) between both groups at 6, 12, 18 and 24 hr, however VAS was significantly higher in the PCA group at week 8 (p=.046) and week 12 (p=.032) . Both groups were comparable regarding ADL and QOL scores (p>.05). Serratus anterior plane block is assumed to be a good alternative for post-thoracotomy analgesia following thoracotomies. The current work hypothesized that SAPB for a week postoperatively, may reduce the emergence of PTPS and may reduce the demand for pain therapy in those patients. The current work hypothesized that SAPB for a week postoperatively, is a good loco-regional alternative for post-thoracotomy analgesia following thoracotomies for chest malignancies, it may reduce the emergence of PTPS and the demand for pain therapy in these patients.

Regional analgesia for minimally invasive cardiac surgery.

Minimally invasive cardiac surgery (MICS) has expanded during the recent years due to interest in improved patient satisfaction and decreased stay in the hospital. To assist in these interests, postoperative pain control is aimed at decreasing opioid usage but maintaining adequate pain control. Regional anesthesia has the ability to provide these goals. This review article will describe different regional anesthesia techniques and discuss the evidence of their use in MICS. A literature search was conducted in MEDLINE (PubMed) and EMBASE with keywords and narrowed to publications between 1998 and 2018. The results are reviewed, analyzed, and discussed in this paper. Thoracic epidurals provide improved pain control and decreased stay in the intensive care unit. Thoracic paravertebral blocks are as effective as thoracic epidurals for postoperative pain control. Serratus anterior plane block provides adequate pain control but does not control pain as well as paravertebral blocks. Intrapleural blocks provide sufficient pain control and can be placed by the surgeon. Pectoral fascial blocks, intercostal blocks, and erector spinae plane blocks described in case reports seem to be viable options for postoperative pain control. As cardiac surgery moves toward smaller incisions and MICS with the goal of enhanced recovery, multimodal analgesic techniques should be explored for postoperative pain control. The regional techniques discussed in this article show a trend toward improved pain control and decreased stay in the intensive care unit.

Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study.

BackgroundReports of postoperative pain treatment after uniportal video-assisted thoracoscopic surgery are limited. Thoracic paravertebral block and serratus anterior plane block have been described recently in pain management after thoracic surgery. A comparison between these two blocks for postoperative analgesia after uniportal video-assisted thoracoscopic surgery has not been previously reported. The aim of this study was to compare the analgesic benefits of serratus plane block and thoracic paravertebral block after uniportal video-assisted thoracoscopic surgery and examined the two block types for noninferiority.MethodsFrom December 2015 to May 2018, a total of 636 relevant records of patients who underwent uniportal video-assisted thoracoscopic surgery under general anaesthesia alone or with the addition of serratus plane block or thoracic paravertebral block performed preoperatively were identified. A propensity-matched analysis incorporating preoperative variables was used to compare the efficacy of postoperative analgesia in three groups.ResultsOverall, 123 patients were identified for analysis. Propensity score matching resulted in 41 patients in each group. The visual analogue scale scores were significantly lower in the serratus plane block group and the thoracic paravertebral block group than in the control group at the 1st, 2nd, 4th, and 6th postoperative hours. Cumulative opioid consumption was significantly lower in the serratus plane and thoracic paravertebral block groups than in the control group at 6 hrs (18.3±3.1 mg, 18.7±3.9 mg vs 21.5±4.4 mg; P=0.001) and 24 hrs (43.4±7.3 mg, 42.5±7.7 mg vs 49.3±8.8 mg; P<0.001) postoperatively. The serratus plane block group was noninferior to the thoracic paravertebral block group on pain score and opioid consumption.ConclusionThe addition of single-injection serratus plane or thoracic paravertebral block is associated with early analgesic benefits in patients undergoing uniportal video-assisted thoracoscopic surgery, including a reduction in the postoperative opioid consumption and pain scores. Serratus plane block is as effective as thoracic paravertebral block for reducing postoperative pain.

Serratus Anterior Plane Block for Post-Thoracotomy Analgesia: a Novel Technique for the Surgeon and Anaesthetist.

Post-thoracotomy pain is one of the most severe forms of post-operative pain. Anaesthetists usually manage post-thoracotomy pain with an epidural or paravertebral block. However, both of these techniques have their limitations. Ultrasound-guided interfascial plane block like serratus anterior plane block is a new concept and is proposed to provide analgesia to the hemithorax. We report our experience with 10 thoracotomy cases where this block was used as a post-operative analgesic technique. Patients undergoing pulmonary metastasectomy or lobectomy received ultrasound-guided serratus anterior plane block between the serratus anterior and the external intercostal muscles with 0.25% ropivacaine, and a catheter was inserted. Post-operatively, 0.125% ropivacaine with fentanyl (1mcg/ml) was given as infusion at 5-7ml/h. Other analgesics were paracetamol and diclofenac. Fentanyl infusion at 0.25mcg/kg/h was the rescue analgesic if pain persisted. Four out of 10 patients required fentanyl infusion. Uncontrolled pain in two of these patients was at the intercostal drain site; in the third patient, two ribs were resected; and in the 4th patient, there was poor drug spread and the catheter could not be placed in the desired plane due to poor muscle mass. The catheter was kept in situ for a minimum of 48h to a maximum of 6days after surgery. Serratus anterior block could be an attractive option for post-thoracotomy analgesia. Further studies can take the help of the surgeon for catheter placement in the desired plane at the time of wound closure to ensure adequate drug spread.

Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy

Objective: To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy. Methods: One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. The control group was only received routine general anesthesia without any block. Patient-controlled intravenous analgesia (PCIA) was performed in all the patients postoperatively. The VAS score at rest or coughing and Ramsay score at 2, 4, 8, 12, 24, 48 h after operation were compared among the three groups. The intraoperative dosages of propofol and remifentanil,press times and sufentanil cumulative dosage of PCIA in 48 hours after operation, postoperative rehabilitation indicators and adverse effects were all compared. Results: In all the three groups,the VAS scores at rest and coughing increased first and then decreased 2 h to 48 h after operation. The VAS scores in SAPB group and ESPB group were lower than that in control group (P<0.05), whereas, no significant difference was observed between SAPB group and ESPB group (P>0.05). For Ramsay score, among the three groups, there were no significances of the main effects of group and time point, as well as interaction effect (all P>0.05). The intraoperative dosages of propofol and remifentanil in SAPB group and ESPB group were lower than those in control group (P<0.05), the press times and sufentanil cumulative dosage of PCIA after operation were also lower than those in control group (P<0.05). There was no significant difference in feeding time after operation among the three groups (P>0.05). The times of first anal exhaust, ambulation and hospitalization after operation in ESPB group and SAPB group were significantly shorter than those in control group (P<0.05). However, there was no significant difference between ESPB group and SAPB group in postoperative rehabilitation indicators mentioned above (P>0.05). The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P<0.05). There was no difference in the incidence of vomiting among the three groups (P>0.05). Conclusions: Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.

Efficacy of ultrasound-guided serratus anterior plane block for postoperative analgesia in patients undergoing thorascopic surgery

Objective To evaluate the efficacy of ultrasound-guided serratus anterior plane block (SAPB) for postoperative analgesia in patients undergoing thoracoscopic surgery. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-24 kg/m2, scheduled for elective thoracoscopic surgery under general anesthesia, were divided into 3 groups (n=20 each) using a random number table method: control group (group C), thoracic paravertebral block(PVB)group (group PVB) and group SAPB.After the patients were turned to contralateral position, thoracic PVB was performed at T4, 6 thoracic vertebrae on the affected side under ultrasound guidance, and 0.25% ropivacaine 20 ml was injected in group PVB.In group SAPB, ultrasound-guided SAPB was performed on the affected side, and 0.33% ropivacaine 30 ml was injected.Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery.PCIA pump was pressed when numerical rating scale scores>3 after surgery and flurbiprofen axetil 2 mg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA pressing, total consumption of drugs during PCIA and requirement for flurbiprofen axetil were recorded at day 3 after surgery.The consumption of sufentanil during operation was recorded, the dose was calculated, and the total amount of sufentanil consumed was recorded.The development of postoperative nausea and vomiting, pulmonary infection and chronic pain was also recorded. Results Compared with group C, the consumption, dose and total consumption of sufentanil were significantly decreased, the number of pressing times of PCIA and total consumption of drugs during PCIA were decreased, and the incidence of postoperative nausea and vomiting was decreased in PVB and SAPB groups (P 0.05). There was no significant difference in the incidence of chronic pain among the three groups (P>0.05), and no patients required additional flurbiprofen axetil. Conclusion Ultrasound-guided SAPB provides good efficacy for postoperative analgesia in the patients undergoing thoracoscopic surgery with fewer adverse effects. Key words: Nerve block; Ultrasonography; Analgesia, postoperative; Thoracoscopy

Comparison of Postoperative Analgesic Consumption of the Erector Spina Plane Block and Serratus Anterior Plane Block

Comparison of Postoperative Analgesic Consumption of the Erector Spina Plane Block and Serratus Anterior Plane Block

Ultrasound-Guided Serratus Anterior Plane Block for Pain Management Following Minimally Invasive Repair of Pectus Excavatum

The Nuss procedure is a preferred technique for minimally invasive repair of pectus excavatum (MIRPE), but it is associated with significant postoperative pain. We assessed the efficacy and safety of an ultrasound-guided bilateral serratus anterior plane block (SAPB) for relieving acute pain from MIRPE. A retrospective cohort study. This study was conducted at the Marmara University Pendik Training and Research Hospital, Turkey. All participants were scheduled for MIRPE. This study was conducted from November 2017 to May 2018. Postoperative pain control was achieved with bilateral SAPB done after induction of anesthesia and IV PCA in 50 patient (SABP group) and with only IV PCA in 45 patients (Control group). SAPB was achieved, targeting the interfascial plane between the serratus anterior and latissimus dorsi muscles, with a single injection of 30 mL (20 mL if patient weighed < 40 kg) of 0.25% bupivacaine and 0.5% lidocaine into each side. Pain scores were recorded for 24 h. Patients in the Control group had a higher demand (mean difference, 61; 95% confidence interval [CI] 30.5-136; P < 0.0001) and delivery dose (mean difference, 25; 95% CI 15-41.5 P = 0.001) during the first postoperative 24 h. SAPB did not affect the median (interquartile range) length of hospital stay: 5 (5-7) days vs. 5 (4-6) days, (P =0.085). Bilateral single-injection SAPB in patients undergoing MIRPE decreases pain and opioid consumption during the early postoperative period.

Efficacy of rhomboid intercostal block for analgesia after thoracotomy.

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3–T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient’s resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study.

Purpose: The study aimed to evaluate the analgesic efficiency of dexmedetomidine (DEX) when added to levobupivacaine in continuous ultrasound-guided serratus anterior plane block (SAPB) performed at the end of major thoracic surgery.Methods: This randomized, double-blind trial included 50 adults undergoing thoracic surgery. Continuous SAPB was performed at the end of surgery. Patients were randomized into two groups. Group L (n=25) received levobupivacaine only while Group DL (n=25) received a mixture of levobupivacaine and DEX. All patients received intravenous (IV) paracetamol every 8 hrs. Morphine IV was given according to VAS score of pain as a 5 mg loading dose. The primary outcome measure was postoperative pain intensity. Secondary outcome measures were postoperative morphine consumption and adverse effects.Results: Analgesia was satisfactory in the two groups up to 24 hrs. VAS score was significantly lower in group DL compared to group L between 6 and 24 hrs postoperatively. Total morphine consumption was significantly lower in group DL compared to group L (p<0.001). Up to 12 hrs postoperatively, sedation score was significantly lower in group DL compared to group L. Afterwards, all patients were fully alert. All values of mean arterial pressure and heart rate were within the clinically accepted ranges. There were no recorded cases of hypotension or bradycardia in the whole studied group.Conclusions: Continuous SAPB with levobupivacaine plus DEX seems to be a promising analgesic alternative following thoracotomy. Combined with IV paracetamol, this approach provided adequate analgesia and proper sedation.Trial registration: ISRCTN registry; study ID: ISRCTN35517318

Ultrasound-guided serratus anterior plane block for analgesia after thoracic surgery.

BackgroundPatients who undergo surgical procedures that impair the integrity of the chest wall frequently experience extremely severe postoperative pain. Opiates and weaker analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are not sufficiently effective in achieving control of severe pain and might cause respiratory and gastrointestinal complications. In the past decade, there has been an increased interest in the use of regional nerve blocks for post-thoracoscopy and post-thoracotomy analgesia.MethodsThis is a prospective, randomized, double-blind and single-center study. We recruited 104 patients who underwent elective thoracoscopy. Prior to surgery, the participating patients were randomized into one of two study groups: Group 1- the “standard control group” that received standard postoperative pain control with intravenous opioids, NSAIDs and acetaminophen (paracetamol) and Group 2- the “block group” that was treated by ultrasound-guided serratus anterior plane (SAP) block (a single injection of 0.25% bupivacaine hydrochloride 2 mg/kg plus dexamethasone 8 mg) with standard postoperative pain control regimen. We compared the clinical, laboratory, and postoperative pain assessment data of both groups.ResultsPatients in the SAP block Group 2 reported significantly lower levels of pain after thoracic surgery as assessed by their visual analog scale scores, as compared to the patients in the standard pain control Group 1 (P<0.001). The total dosage of morphine and tramadol required for pain relief during the first hours after surgery was significantly lower in the patients who received SAP block. Also, the incidence of vomiting after surgery was significantly lower among the patients who received SAP block than among the patients who received standard pain control.ConclusionThe results of the present study suggest that SAP block is an effective adjuvant treatment option for post-thoracic surgery analgesia. Compared to the current methods used for post-thoracic surgery pain relief, SAP block has some significant merits, particularly its ease of use and its low potential for side effects.

Serratus anterior plane block for upper abdominal incisions.

Regional anaesthetic techniques for patients undergoing laparotomy have been shown to provide optimal postoperative analgesia and allow early mobilisation, and thus, enhance recovery. The serratus anterior plane block, first documented in 2013, has been suggested as a potential alternative to thoracic paravertebral and central neuraxial blockade for chest wall and upper abdominal incisions as it can provide analgesia from T2 to T9. Although there are published cases of this block being used for chest wall analgesia, there are currently no published cases of this block being used for abdominal incisions. We report our experience with two patients, using ultrasound-guided serratus anterior plane blockade with catheter insertion following laparotomy.

Progresses in the study of serratus anterior plane block in postoperative analgesia in thoracic surgery

Serratus anterior plane(SAP) block is a simple and practical regional nerve block technique. After thoracic surgery, it provides effective analgesia for chest wall. Ultrasound-guided visualization technology further improves the success rate of block and reduces the series of complications caused by incomplete analgesia. This article reviews the recent studies on ultrasamd-guided SAP block at home and abroad, and summarizes its anatomical basis, specific block area and clinical application, so as to provide reference for clinical application. Key words: Analgesia; Serratus anterior plane block; Thoracic surgery

Serratus anterior block for pain relief in multiple rib fractures: Case report (serratus anterior block in multiple rib fractures)

Introduction: Chest trauma is the most common cause of multiple fractured ribs. Multiple rib fractures result in intensive pain and can be a cause of respiratory failure and pneumonia. Thoracic epidural and thoracic paravertebral blocks are effective but potentially invasive techniques to relieve the pain in patients with multiple rib fractures. Ultrasound guided serratus anterior plane block is a relatively newer technique that is less invasive, easier to perform, with low risk of complications. Case report: 34-year-old patient with chest trauma and multiple rib fractures suffering with intensive pain regardless of multimodal intravenous analgesia was given bilateral serratus anterior plane block. Under ultrasound guidance, a bolus dose of 20 ml 0.25% levobupivacaine and 4 mg of Dexamethasone was injected in the space between the serratus anterior and latissimus dorsi muscles. Catheters were inserted and an infusion of 0.0625% levobupivacaine was given at 10 ml / 2-4 hr. Pain scores were recorded with Numerical Rating Scale (NRS) before and after the block. Patient had pain relief following the block of 50% with in an hour, as pain score before block was 10/10 NRS while after block was 5/10 NRS. After continuous infusion of local anesthetic pain score was 0-1/10. No additional doses of analgesics were required. Conclusion: In our patient serratus anterior plane block provided effective analgesia in patient with multiple rib fractures. The serratus anterior plane block can be an alternative to thoracic epidural and paravertebral blocks.

By Ultrasonic-Guided Erector Spinae Block, Thoracic Paravertebral Block versus Serratus Anterior Plane Block by Articaine with Adrenaline during Breast Surgery with General Anesthesia: A Comparative Study of Analgesic Effect Post-Operatively: Double Blind Randomized, Controlled Trial

Background and Aims: Erector spinae plane block, Paravertebral block and serratus anterior block are three formats for analgesia post-operatively following radical mastectomy. This study compares the analgesic efficacy of these modalities for analgesia post-operatively by articaine 2% with adrenaline. Methods: Seventy-five patients with ASA physical status I or II subjected to modified radical mastectomy with axillary clearance were enrolled for the study. After induction of general anaesthesia all patients received 20 mL 2% articaine with adrenaline in each technique of the study. Patients in Group 1 (Erector spinae block [ESB], n = 25), Group 2 paravertebral block [PVB] n = 25), Group 3 (serratus anterior plane block [SAPB] n = 25) were ultrasound-guided on ipsilateral side. Patients were estimated for pain scores at 0, 2, 4, 6, 12 and 24 h, and duration of analgesia post-operatively and relieve analgesic doses required of morphine up to 24 h. Results: Visual analogue scale scores post-operatively were lower in ESB and PVB group compared with SAPB at 4, 6, 12 and 24 h (P < 0.05). The first analgesic dose requirement was significantly longer in ESB (416 ± 68 min) than PVB group (371 ± 67 min) in compared with SAPB (343.5 ± 54.7 min). Mean duration of analgesia was significantly longer in ESB and PVB group (P < 0.001) in compared with SAPB. Total morphine dose of relieving analgesic was significantly lesser in ESB (4 ± 2 mg) than PVB group (6 ± 2 mg) compared with SAPB (7 ± 2 mg) up to 24 h. ESB was easy technique and has less side effect on compared with PVB. As regard block-related complications including (accidental vascular puncture, pneumothorax, nerve damage, local anesthetics toxicity), there were no significant adverse effects noted in three groups. However, only a case of pneumothorax in (PVB) and a two patients’ blood was aspirated when the paravertebral space was entered which required second trial at the blocks. Conclusion: Sonar-guided erector spinae block and thoracic paravertebral block minimize post-operative pain scores, prolongs the duration of analgesia and diminishes requirements for assigning analgesics in the first 24 h of post-operative period compared to ultrasound-guided serratus anterior plane block but, ESB technique was more potent, easily and less side effect in compared with PVB.

Torakotomi analjezisi için uygulanan serratus anterior alan ve torakal epidural blok etkinliklerinin karşılaştırılması

Aim: Currently, regional anesthesia methods are frequently used for post-thoracotomy pain. In this study, we aimed to compare the efficacy of serratus anterior plane block and thoracic epidural block for pain after thoracotomy.Methods: This retrospective study included 120 patients who underwent thoracotomy. Seventy patients who met the inclusion criteria were evaluated in two groups as Group E (thoracic epidural block) (n=37) and Group S (serratus anterior plane block) (n=33). Postoperative 2nd, 6th, 12th and 24 hour visual analogue scale scores and total analgesic consumption for 24 hours were evaluated. Secondary outcomes were determined as side effects, additional analgesic drug requirement and complications.Results: In the comparison between the groups, there was no statistically significant difference between two groups in terms of Postoperative 2nd (p=0.417), 6th (p=0.271), 12th (p=0.734) and 24 hour (p=0.157) visual analogue scale scores ​​and the amount of total analgesic consumption for 24 hours (p=0.714). There was no statistically significant difference between two groups with regard to the side effects nausea and vomiting (p=0.714), pruritus (p=N/A), respiratory depression (p=N/A) levels. Conclusion: The results of this study demonstrate that use of serratus anterior plane block and thoracic epidural block administration has similar outcomes for post-thoracotomy analgesia.

Serratus anterior plane block for minimal invasive heart surgery

BackgroundMinimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS.MethodsIt’s retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France. All patients scheduled for MIHS was included. Data was collected retrospectively. During this period, 20 patients had SAPB and 26 had CWI. SAPB was performed before extubation with a single injection of 0.5 mg/kg of ropivacaïne (5 mg/ml). In the CWI group, catheter was inserted in the subcutaneous space by the surgeon at the end of the procedure. A 10 ml bolus of ropivacaïne (7.5 mg/mL) was followed by a continuous infusion (2 mg/ml) between 7 and 12 ml/h for 48 h. Morphine consumption and visual analog score (VAS) were recorded for 48 h. Length of stay in intensive care unit and hospital was also collected.ResultsMorphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group.ConclusionSAPB appears effective in reducing postoperative MIHS pain.

An update on regional analgesia for rib fractures.

To provide an update on new strategies for pain management after rib fractures utilizing regional analgesia. Pain management for patients with rib fractures can be very challenging. Traditionally, intravenous patient-controlled analgesia (IVPCA) with opioids, epidural, and paravertebral blocks have been used. These techniques, however, may be contraindicated or have limited application in certain patient populations. Recently, ultrasound-guided myofascial plane blocks such as the erector spinae plane (ESP) block and the serratus anterior plane (SAP) block have emerged as alternatives; providing excellent analgesia with minimal side effects. These blocks have the flexibility to be employed in a wide variety of circumstances where epidural and paravertebral approaches may not be feasible such as in anticoagulated patients and in patients with vertebral fractures where positioning options are limited. Myofascial blocks are less invasive and allow for broader and earlier application (e.g. in the emergency department). Further research on myofascial plane blocks is a priority. Until recently, epidural, paravertebral, and intercostal blocks have been advocated as primary management techniques for pain associated with rib fractures. Newer myofascial plane blocks may play a key role in the future as part of alternative pain management strategies.

Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study

A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy. A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention. An intravenous patient-controlled analgesia (PCA) device was used to deliver fentanyl in both groups. Using the Visual Analog Scale (VAS), the patients' pain was assessed at intervals of 1, 6, 12 and 24 hours after entering the recovery room. Intravenous acetaminophen was administered as a rescue analgesic if the pain exceeded 3 on the VAS. A total amount of fentanyl consumed, the time to first PCA request, a total amount of acetaminophen consumption and possible adverse effects were evaluated. The pain scores assessed at the time intervals were not significantly different between the two groups (p>0.5). The total consumption of fentanyl was significantly lower in the SAB group than in the CTL group (p=0.0001). Duration of the time to first PCA request was remarkably longer in the SAB group than in the CTL group (p=0.0001). The total amount of acetaminophen consumed was notably higher in the CTL group than in the SAB group (p=0.001). None of the patients experienced side effects. Undertaking serratus anterior block following mastectomy can reduce pain scores and lower opioid usage.

Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the Management of Postoperative Thoracotomy Pain After Pediatric Cardiac Surgery

The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery. A prospective, randomized, single-blind, comparative study. Single-institution tertiary referral cardiac center. The study comprised 108 children with congenital heart disease requiring surgery through a thoracotomy. Children were allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal and fentanyl was used for rescue analgesia. A modified objective pain score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in the 3 groups. The late mean MOPS was significantly lower in the SAPB group compared with that of the ICNB group (p < 0.001). The Pecs II group also had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p < 0.001), but the MOPS was comparable at hour 12 (p = 0.301). The requirement for rescue fentanyl was significantly higher in ICNB group in contrast to the SAPB and Pecs II groups. SAPB and Pecs II fascial plane blocks are equally efficacious in post-thoracotomy pain management compared with ICNB, but they have the additional benefit of being longer lasting and are as easily performed as the traditional ICNB.