Comparative Study between Ultrasound-Guided Serratus Anterior Plane Block versus Thoracic Epidural Analgesia for Post-Thoracotomy Pain: A Prospective, Randomized, Clinical Trial

Abstract

Objectives and Aim: Thoracotomies are widely recognized to cause acute pain which is associated with many complications. The target study aimed to assess the safety and efficacy of SAPB compared to TEA for relieving severe thoracotomy pain. Patients and Methods: Forty patients scheduled for thoracotomy randomly allocated either to receive SAPB or thoracic epidural (TEA). Visual analogue pain score (VAS) at rest and coughing every 6 hrs. Postoperative, hemodynamic parameters (heart rate and MAP), pain rescue analgesic consumption in the first 24 hrs., complications, and duration of hospital stay recorded. Results: In our study, we found that the recently described SAPB, while maintaining stable blood pressure, provided excellent analgesia comparable to that offered by TEA for acute post-thoracotomy pain. Hypotension was more noteworthy in those who had epidurals than those with serratus anterior plane (SAP) catheters. Morphine rescue analgesia, as well as Visual Analogue Scale (VAS) pain scores during normal tidal breathing, were like in both groups. Conclusion: We recommend that the Serratus anterior plane block appears to be a safe and effective alternative for postoperative analgesia after thoracotomy.

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

“…Figure 2a and 2b illustrates the risk of bias evaluation for the selected studies. Random allocation was applied in almost all included trials [ 10 , 12 , 19 , 21 , 22 ], except in one trial [ 9 ]. Bias from intended interventions was low due to the awareness of participants and people delivering the intervention.…”

“…All included studies report 24-h postoperative VAS [ 10 , 11 , 12 , 17 , 19 , 20 ]. There was significant heterogeneity among the trials ( χ 2 = 361.54, P < 0.00001, I 2 = 99%).…”

“…Five studies reported the VAS score on 12 h postoperative [ 11 , 12 , 17 , 19 , 20 ]. Heterogeneity was found in the pooled results of the trials ( χ 2 = 170.56, P < 0.00001, I 2 = 98%) and significantly no difference in pain on 12 h postoperative in both the groups (MD = -0.06, Z = 0.15, P = 0.88) [ Figure 4b ].…”

“…However, both of these studies did not compare SAPB with recommended analgesic for thoracic surgery, TEA. The occurrence of PONV in two studies suggests a lower incidence in SAPB compared to TEA [ 17 , 18 ], while other studies reported an equal [ 10 ] or a higher incidence of PONV in SAPB [ 11 , 12 , 19 ].…”

“…Abdelzaam et al . [ 19 ] found no statistically significant disparity between SAPB and TEA in the case of VAS. This dispute encourages the current study to perform a comparison between SAPB and TEA to determine which is the safer and effective pain prevention and management for surgeries.…”