Ultrasound-guided Serratus Anterior Plane Block Research Articles

Comparison Between Erector Spinae Plane Block versus Serratus Anterior Plane Block Regarding Analgesia and Stress Response After Modified Radical Mastectomy: Randomized Controlled Trial.

Modified radical mastectomy (MRM) is the primary surgical treatment for breast cancer, yet it leads to significant postoperative pain. This randomized controlled trial evaluates the effects of an erector spinae plane block (ESPB) versus a serratus anterior plane block (SAPB) on post-MRM pain management and stress response reduction. Sixty individuals scheduled for unilateral MRM under general anesthesia from October 2021 to October 2022 were divided into three groups. Group A comprised 20 patients who received ultrasound-guided ESPB (20 mL of 0.25% bupivacaine). Group B included 20 patients who received ultrasound-guided SAPB (20 mL of 0.25% bupivacaine). Group C was treated with intravenous morphine based on pain scores. Anesthesia was induced using 2 μg/kg of fentanyl and 2 - 3 mg/kg of propofol. The study compared the three groups regarding pain scores using a numerical rating scale, serum cortisol levels, total fentanyl, and morphine consumption, changes in mean arterial blood pressure (MAP) and heart rate (HR) during surgery, and the occurrence of postoperative complications. Statistically significant reductions in pain scores were observed in group A compared to groups B and C. Moreover, group A exhibited a significant decrease in postoperative morphine consumption, serum cortisol levels 1 hour post-surgery (P = 0.021), MAP, and postoperative vomiting and nausea compared to group B. Furthermore, groups A and B showed statistically significant improvements in all parameters compared to group C. The study demonstrates that ESPB provides superior analgesic effects compared to SAPB in patients undergoing MRM, with reduced morphine use and lower postoperative cortisol levels. Both blocks offer more effective pain control than intravenous morphine alone.

Effects of Adding Dexamethasone Plus Ketamine to Bupivacaine for Ultrasound-guided Serratus Plane Block as Analgesia in Major Breast Surgery: A Randomized, Double-blind Trial

BACKGROUND: Post-operative pain after mastectomy is associated with poor recovery, prolonged hospital stays, and increased liability for chronic persistent pain. AIM: This work aimed to test the analgesic efficacy of adding ketamine to a dexamethasone bupivacaine combination in ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing modified radical mastectomy (MRM). METHODS: This randomized, double-blind trial included 60 females aged 20–60 undergoing MRM. They were randomized into two groups: Group DB (n = 30) received SAPB using 30 ml of bupivacaine 0.25% and dexamethasone 4 mg. Group KD (n = 30) received the same block with the addition of ketamine 50 mg. RESULTS: The time to the first analgesic request was significantly delayed in Group KD than in Group DB (p < 0.001). The number of patients requiring morphine and its total consumption during the first 24 post-operative hours in Group KD were significantly less than in Group DB (p = 0.001 and p < 0.001, respectively). Visual Analog Scale scores at rest and movement at 4, 6, 8, 10, 12, and 18 h were significantly lower in Group KD than in Group DB. CONCLUSIONS: Adding ketamine to bupivacaine plus dexamethasone in ultrasound-guided SAPB is associated with better analgesic outcomes in patients undergoing MRM, including prolonged duration of analgesia and decreased post-operative morphine consumption and pain scores at rest and movement.

Enhancing ergonomics in rib counting in ultrasound-guided serratus anterior plane block.

Enhancing ergonomics in rib counting in ultrasound-guided serratus anterior plane block.

Ultrasound-guided serratus anterior plane block to prevent neurocognitive impairment in elderly patients after thoracoscopic lobectomy: protocol for a single-centre, double-blind, randomised controlled trial

IntroductionPostoperative neurocognitive dysfunction (PND), including postoperative delirium (POD), is a common complication in elderly patients after major surgeries, often leading to poor postoperative recovery. Although the pathological mechanism underlying PND...

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

Evaluating Modified Ultrasound-Guided Serratus Anterior Plane Block for Enhanced Postoperative Recovery in Thoracoscopic Lobectomy Patients

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.].

Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial

BackgroundPostoperative analgesia in the cardiothoracic ICU has traditionally relied on intravenous opioids. Thoracic nerve blocks are attractive alternatives for analgesia that reduce the requirement for opioids, but their safety and feasibility remain unclear. MethodsSixty children were allocated randomly to three groups: group C received intravenous opioids alone, while group SAPB (deep serratus anterior plane block) and group ICNB (intercostal nerve block) received opioids combined with ultrasound-guided regional nerve blocks (0.2% ropivacaine 2.5 mg.kg−1) after patients were transferred to the ICU. The primary outcome was opioid requirement in the first 24 h after surgery. Other outcomes included the postoperative FLACC scale value, tracheal extubation time, and plasma ropivacaine concentrations after the block. ResultsThe mean [sd] cumulative dose of opioids administered postoperatively within 24 h in the SAPB (168.6 [76.9] μg.kg−1) and ICNB groups (170.0 [86.8] μg.kg−1) were significantly lower by nearly 53% than those in group C (359.3 [125.3] μg.kg−1, p = 0.000). The tracheal extubation time was shorter in the regional block groups than that in the control group, but the difference was not statistically significant (p = 0.177). The FLACC scale values at 0, 1, 3, 6, 12, and 24 h post-extubation were similar in the three groups. The mean peak plasma ropivacaine concentrations in the SAP and ICNB groups were 2.1 [0.8] and 1.8 [0.7] mg.L−1, respectively, 10 min post-block and then slowly decreased. No noticeable complications associated with regional anesthesia were observed. ConclusionsUltrasound-guided SAPB and ICNB provided safe and satisfactory early postoperative analgesia while reducing opioid consumption following sternotomy in pediatric patients. Clinical trial registrationChinese Clinical Trial Registry ChiChiCTR2100046754.

Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial

Background & Objective: Standard pain management technique after thoracic surgery is thoracic epidural analgesia, parentral analgesics and nerve blocks. Thoracic epidural analgesia (TEA) has many known complications, including respiratory depression and urinary retention. Serratus anterior plane block (SAPB) is a simple procedure, which provides postoperative pain relief by blocking the lateral cutaneous branches of T2–T9 spinal neurons. We compared the analgesic efficacy of both of these techniques in thoracotomy patients in this randomized trial.
 Methodology: The study involved 74 cancer patients scheduled for thoracotomy. The patients were randomly divided into two groups. The patients in Group SAPB underwent ultrasound-guided serratus anterior plan block (SAPB) with catheter insertion. The second group (Group TEA) underwent TEA with preoperative indwelling catheter insertion. In both groups blocks were activated before induction of routine general anesthesia (GA) by a bupivacaine bolus dose, then continued as bupivacaine infusion in ICU for postoperative analgesia. Hemodynamic monitoring was started. Intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesic were noted including MAP in the two groups.
 Results: Both groups were statistically comparable regarding intraoperative fentanyl consumption, postoperative morphine consumption, and time to first request for analgesia in the two groups. Hypotensive episodes were significantly more frequent (P < 0.001) in the TEA group (n = 17; 45.9%) compared to the Group SAPB (n = 2; 5.4%). Ramsey sedation scores (RSS) were comparable in the two groups immediately postoperatively and after 2 h. After 4 h after recovery all patients in both groups had an RSS of 2.
 Conclusion: Ultrasound-guided serratus anterior plane block is associated with reduced intraoperative and postoperative fentanyl consumption, but the Ramsey sedation scores were equivalent in the two groups after recovery and upto 4h.
 Abbreviations: GA: General Anesthesia; PTPS: Post-Thoracotomy Pain Syndrome: RSS: Ramsey Sedation Score; SAPB: Serratus Anterior Plane Block; TEA: Thoracic Epidural Analgesia; VATS: Video-Assisted Thoracoscopic Surgery
 Key words: Pain, Postoperative; Serrataus plane block; Thoracotomy; Ultrasound; Thoracic epidural
 Citation: Gamal RM, Bossily SS, Ali AR, Samy SF, Seif NE, Ahmed HI. Serratus anterior plane block versus thoracic epidural block in patients undergoing thoracotomy: a randomized double-blind trial. Anaesth. pain intensive care 2023;27(3):389−395.
 DOI: 10.35975/apic.v27i3.2243
 Received: March 06, 2023; Reviewed: March 31, 2023; Accepted: April 01, 2023

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

Comparative efficacy of serratus anterior plane block (SAPB) and fentanyl for postoperative pain management and stress response in patients undergoing minimally invasive cardiac surgery (MICS).

Fast-tracking plays a significant role in reducing perioperative morbidity and postoperative hospital stay by facilitating early extubation and optimal pain control. Attenuating the stress response to surgery also has a crucial function in enhancing recovery. Serratus anterior plane block (SAPB) is a recently described technique for chest wall analgesia. More data is required to find out the effectiveness of analgesia by SAPB for minimally invasive cardiac surgery (MICS). The study aimed to assess the efficacy and safety of ultrasound-guided SAPB compared to fentanyl for controlling post-thoracotomy pain and stress response in patients undergoing MICS. Time framed comparative, prospective, and observational study. Patients undergoing MICS for coronary artery bypass grafting under general anesthesia were randomly assigned into two groups. SAPB group (Group A) patients were given 0.2% of 20 ml ropivacaine followed by catheter insertion for continuous infiltration at the end of the procedure. Fentanyl group (Group B) patients were given fentanyl infusion for postoperative analgesia. The primary outcome measured changes in visual analog scale (VAS) score (pain) and cortisol levels (for stress response) in both groups. VAS score was significantly low in Group A when compared to Group B (P < 0.0001). Cortisol levels were also lower in the SAPB group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, pulse rate, and oxygen saturation) were more stable in Group A with a lesser requirement of top-up analgesics. SAPB was more effective than fentanyl in managing post-thoracotomy pain after MICS. Cortisol level was lower in the group that received SAPB.

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.

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.

The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study.

Aim:To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia.Methods:This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room.Results:Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups.Conclusions:Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.

Ultrasound-guided Bilateral Serratus Anterior Plane Block for Postoperative Analgesia in Ear Reconstruction after Costal Cartilage Harvest: A Randomized Controlled Trial.

Costal cartilages harvest for ear reconstruction is accompaniedby severe pain in chest. However, there is no perfect solution for reducing this chest pain. Evaluate the efficacy and safety of analgesia using ultrasound-guided bilateral serratus anterior plane block (SAPB) in children receiving costal cartilage harvest for ear reconstruction. Sixty children undergoing ear reconstruction using costal cartilage were randomized to an SAPB group (SAPB with 3 mg/kg 0.25% ropivacaine) or an incision infiltration (II) group (II with 3 mg/kg 0.75% ropivacaine), and 29 in each group completed the study. All children received patient-controlled intravenous analgesia (PCIA). The primary outcomes were numerical rating scale (NRS) scores of pain while rest and coughing at 1, 6, 12, 24, and 48 h after surgery. The secondary outcomes were sufentanil use within 24 h, duration of analgesia, use of oral rescue analgesics, first time out of bed, and incidence of treatment-related adverse effects. The SAPB group had lower rest and coughing NRS scores at 6 and 12 h after surgery (all P &lt; 0.001), but the scores were similar at other times. The SAPB group used less sufentanil within 24 h, but had a longer duration of analgesia (both P &lt; 0.001). The II group used more oral rescue analgesics within 48 h, had a longer time until first time out of bed, and had more opioid-related side effects (all P &lt; 0.01). There were no SAPB-related complications. Ultrasound-guided SAPB can provide safe and effective regional pain relief after costal cartilage harvest for ear reconstruction. 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 https://www.springer.com/00266 .

A comparative study between ultrasound-guided serratus anterior plane block and conventional IV analgesics for post-operative pain management in modified radical mastectomy

BackgroundSurgery is the first line of treatment for early, localized, or operable breast cancer and it is associated with severe post-operative pain. Although opioids have been the mainstay for managing post-operative pain, they have undesirable side effects. A variety of methods, including thoracic epidural, paravertebral, and intercostal blocks have been used to manage breast surgery pain; however, each of these blocks has some drawbacks. Serratus anterior plane block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve. This study compares between the effect of serratus anterior plane block and conventional IV analgesia on post-operative pain after modified radical mastectomy.ResultsPost-operative pain scores were significantly lower in the SAPB group in the first 8 h compared to the control group (P < 0.05), the time to the first rescue analgesic was significantly longer in the SAPB group with a mean 354 min compared to the control group; the mean is 17.8 min, the total dose of rescue analgesic was significantly lower in the SAPB group with a mean 50 mg in the first 24 h compared to a mean of 212.5 mg in the control group. The patient’s satisfaction scores were higher, the incidence of post-operative nausea and vomiting was significantly lower among the SAPB group compared to the control group. No other complications were recorded in either group.ConclusionsThe serratus anterior plane block can be used as one of the modalities in managing the pain of patients undergoing MRM surgery. This procedure was effective in reducing the need for post-operative opioids usage, better patient satisfaction with fewer side effects as post-operative nausea and vomiting. It is simple and easy-to-learn technique.

Combination of Ultrasound-Guided Serratus Anterior Plane Block and Rectus Sheath Block Provide Analgesia for Open Hepatectomy: A Report on 3 Cases

Perioperative analgesia in open hepatectomy is challenging because a large subcostal arc incision is often required. Extensive dissection of muscles and nerves is associated with severe intraoperative hemodynamic fluctuations and postoperative pain. Serratus anterior plane block (SAPB) and rectus sheath block (RSB) are commonly used for anesthesia and postoperative analgesia in patients undergoing chest wall surgery and abdominal surgery, respectively. In this case-series report, we present our experience with three patients in whom open hepatectomy and early extubation were performed successfully under a combination of ultrasound-Guided SAPB and RSB. Three patients were scheduled for open hepatectomy, all of them were diagnosed with severe hepatitis B cirrhosis. After due deliberation and with the consent of patients and their family, ultrasound-guided right SAPB and bilateral RSB were performed with the patient in the supine position. A total of 0.7mL/kg of 0.25% ropivacaine was used for nerve block. Sensory loss to pinprick from T5 to T10 was achieved in all three patients 20 min after administration of blocks. The operation went smoothly for all the patients. All three patients experienced quiet recovery and early extubation, and none of them complained of discomfort in the surgical site in the first 12 h after surgery. Here we present three cases of a combination of ultrasound-guided SAPB and RSB that may be an attractive option for anesthetic management of open hepatectomy in clinical practice.

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

Objective To investigate the anesthetic effect of anterior serratus muscle plane block under ultrasound guidance in arthroscopic shoulder surgery and its effect on postoperative analgesia. Methods A total of 94 patients who received arthroscopic shoulder surgery in our hospital were selected as the research subjects, and they were divided into a control group and a study group according to the random number table method. The control group underwent brachial plexus block under ultrasound guidance, and the study group underwent anterior serratus plane block under ultrasound guidance. The visual analogue score (VAS) of pain at each time point, intraoperative anesthetic dosage, the use of postoperative analgesic, pain mediators and oxidative stress factors before and after surgery, and the occurrence of adverse reactions were compared between the two groups after surgery. Results At 6, 12, 48, and 72 h after surgery, there was no obvious difference in the VAS score between the two groups (P > 0.05); 24 h after surgery, the VAS score of the study group was significantly lower than that of the control group (P < 0.05). The intraoperative dosage of propofol and remifentanil in the study group was significantly lower than that in the control group (P < 0.05). The number of effective compressions of analgesic pump and the total amount of sufentanil in the study group were significantly lower than those in the control group within 48 hours after operation, and the time of first compressions of analgesic pump was significantly longer than that in the control group (P < 0.05). Before surgery, there were no significant differences in CGRP, NPY, and MDA levels and SOD enzyme activity between the two groups (P > 0.05). After surgery, the levels of pain mediators CGRP and NPY in the study group were lower than those in the control group (P < 0.05). The level of MDA was lower than that of the control group, and SOD enzyme activity was higher than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion Ultrasound-guided anterior serratus plane block for arthroscopic shoulder surgery has a good anesthesia effect and long action time. It can significantly reduce the dosage of opioids, enhance the postoperative analgesic effect, effectively inhibit postoperative pain and oxidative stress reaction, and has good safety.