Are Thoracic Wall Blocks Efficient After Video-Assisted Thoracoscopy Surgery-Lobectomy Pain? A Comparison Between Serratus Anterior Plane Block and Intercostal Nerve Block

Baldinelli, Francesco; Capozzoli, Giuseppe; Pedrazzoli, Roberta; Feil, Birgit; Pipitone, Marco; Zaraca, Francesco

doi:10.1053/j.jvca.2020.09.102

Cited by 21 publications

(12 citation statements)

References 18 publications

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“…The hemodynamics in group N was more stable than that in group C, especially in the initial stage of the skin incision. Consistent with previous studies [ 19 – 21 ], the patients in group N required lower dosages of propofol and remifentanil. Two hours after the thoracic incision, the blood glucose was significantly higher than the baseline values.…”

Section: Discusionsupporting

confidence: 89%

The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Prospective Randomized Study

et al. 2023

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Introduction We estimated the safety and efficacy of ultrasound-guided multipoint fascial plane block, including serratus anterior plane block (SAPB) and bilateral transversus abdominis plane block (TAPB) in elderly patients who underwent combined thoracoscopic–laparoscopic esophagectomy (TLE). Methods The authors enrolled 80 patients in this prospective study after patient selection using the inclusion and exclusion criteria who were scheduled for elective TLE from May 2020 to May 2021. Patients were randomly assigned to the treated group (group N) or the control group (group C) ( n = 40 per group) using the sealed-envelope method. Multipoint fascial plane blocks, including serratus anterior plane block (SAPB) and bilateral TAPB, were performed on patients undergoing TLE using a solution of 60 mL 0.375% ropivacaine plus 2.5 mg dexamethasone by 3 injections of 20 mL each (group N) or no interventions (group C). Results Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at T incision and 30 min after T incision were significantly higher in group C than in group N, and also significantly higher than at baseline ( P < 0.01). Blood glucose at 60 min, 2 h after T incision, was significantly higher in group C than in group N and significantly higher than at baseline ( P < 0.01). Compared to group N, the dosages of propofol and remifentanil used during surgery in group C were more than those in group N ( P < 0.01). The time to first rescue analgesic in group C was earlier than in group N. The total postoperative use of sufentanil, and the number of patients requiring rescue analgesics in group C, were more than in group N ( P < 0.01). Conclusions This study showed that applying the multipoint fascia pane block technique in TLE for elderly patients could significantly reduce postoperative pain, decrease the dosages of drugs used in general anesthesia, improve the quality of the awakening, and have no obvious adverse reactions. Trial Registration: Chinese Clinical Trial Registry (ChiCTR-2000033617).

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Section: Discusionsupporting

confidence: 89%

The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Prospective Randomized Study

et al. 2023

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“…Alternatives such as serratus block or intercostal block have been widely studied and seem to have similar results in postoperative pain care. Some studies found a better effect of PVB-US . In our study, we hypothesized that local analgesia administered by the surgeon would have been noninferior compared with PVB-US.…”

Section: Discussionmentioning

confidence: 88%

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Chenesseau,

Fourdrain,

Pastene

et al. 2023

JAMA Surg

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ImportanceIn minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)–guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options.ObjectiveTo demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group.Design, Setting, and ParticipantsIn this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS).InterventionsPVB-VATS or PVB-US.Main Outcomes and MeasuresThe primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications.ResultsA total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: −5.4 mg; 95% CI, −∞ to −0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups.Conclusions and RelevancePVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours.Trial RegistrationClinicalTrials.gov Identifier: NCT04579276

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“…238,239 A continuous SAP block for a week after thoracotomy for lung cancer reported equivocal findings for the incidence of postthoracotomy pain syndrome compared to the PCA group (Category A3-E evidence). 240 For patients undergoing MITS, SAPB was superior to local infiltration, 241 noninferior to ICNB 242 and PVB, 243,244 as well as inferior to ESPB 223,224,245 with regard to pain scores, 223,241,242,244 opioid consumption, 224,243,244 or improved recovery 245 (Category A2-B evidence 223,224 /Category A2-E evidence [241][242][243]245 and Category B2-B evidence 244 ). In patients undergoing thoracotomy, SAPB-related analgesia was comparable to PVB 246 and inferior to TEA 222 (Category A2-E evidence).…”

Section: Fascial Plane Blocksmentioning

confidence: 99%

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Makkad

Heinke

Sheriffdeen

et al. 2023

Anesthesia &Amp; Analgesia

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Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee’s Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use–focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.

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Are Thoracic Wall Blocks Efficient After Video-Assisted Thoracoscopy Surgery-Lobectomy Pain? A Comparison Between Serratus Anterior Plane Block and Intercostal Nerve Block

Cited by 21 publications

References 18 publications

The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Prospective Randomized Study

The Role of Ultrasound-Guided Multipoint Fascial Plane Block in ElderlyPatients Undergoing Combined Thoracoscopic–Laparoscopic Esophagectomy: A Prospective Randomized Study

Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

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