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

Kaushal, Brajesh; Chauhan, Sandeep; Saini, Kulbhushan; Bhoi, Debesh; Bisoi, Akshay Kumar; Sangdup, Tsering; Khan, Maroof Ahmad

doi:10.1053/j.jvca.2018.08.209

Cited by 97 publications

(96 citation statements)

References 22 publications

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“…rib fractures; neuropathic pain management; and insertion of intercostal drains (Biswas et al, 2018; Chu & Jarvis, 2017; Kaushal, Chauhan, | 837 HANLEY Et AL. Saini, Bhoi, & Bisoi, 2018;Khalil, Abdallah, Bashandy, & Kaddah, 2017;Okmen & Metin Ökmen, 2018;Okmen & Ökmen, 2017;Saad et al, 2018;Thiruvenkatarajan, Cruz Eng, & Adhikary, 2018).…”

Section: F I G U R E 4 Numerical Rating Scalementioning

confidence: 99%

Ultrasound‐guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic‐assisted thoracic surgery

Hanley

Wall

Bukowska

et al. 2020

European Journal of Pain

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Background The deep serratus anterior plane block (SAPB) is a promising novel regional anaesthesia technique for blockade of the anterolateral chest wall. Evidence for the efficacy of SAPB versus other analgesic techniques in thoracic surgery remains inadequate. Aims This study compared ultrasound‐guided continuous SAPB with a surgically placed continuous thoracic paravertebral block (SPVB) technique in patients undergoing videoscopic‐assisted thoracic surgery (VATS). Methods In a single‐centre, double‐blinded, randomized, non‐inferiority study, we allocated 40 patients undergoing VATS to either SAPB or SPVB, with both groups receiving otherwise standardized treatment, including multimodal analgesia. The primary outcome was 48‐hr opioid consumption. Secondary outcomes included numerical rating scale (NRS) for postoperative pain, patient‐reported worst pain score (WPS) as well as functional measures (including mobilization distance and cough strength). Results A 48‐hr opioid consumption for the SAPB group was non‐inferior compared with SPVB. SAPB was associated with improved NRS pain scores at rest, with cough and with movement at 24 hr postoperatively (p = .007, p = .001 and p = .012, respectively). SAPB was also associated with a lower WPS (p = .008). Day 1 walking distance was improved in the SAPB group (p = .012), whereas the difference in cough strength did not reach statistical significance (p = .071). There was no difference in haemodynamics, opioid side effects, length of hospital stay or patient satisfaction between the two groups. Conclusions The SAPB, as part of a multimodal analgesia regimen, is non‐inferior in terms of 48‐hr opioid consumption compared to SPVB and is associated with improved functional measures in thoracic surgical patients. ClinicalTrials.gov Identifier: NCT03768193. Significance The SAPB interfascial plane block is an efficacious alternative method of opioid‐sparing analgesia in high‐risk thoracic surgical patients as part of an enhanced recovery programme.

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Section: F I G U R E 4 Numerical Rating Scalementioning

confidence: 99%

Ultrasound‐guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic‐assisted thoracic surgery

Hanley

Wall

Bukowska

et al. 2020

European Journal of Pain

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“…To date, we are not aware of any prospective study comparing the use of the serratus anterior, erector spinae, and pectoralis nerve blocks in cardiothoracic patients. Kaushal et al demonstrated evidence that SAP and PEC nerve blocks are both superior to intercostal nerve blocks in providing prolonged postoperative pain control following thoracotomy in pediatric cardiac cases, and Berthoud et al demonstrated that SAP block provided better pain management than continuous wound infiltration after minimally invasive heart surgery. Our institutional experience with the use of SAP and PEC nerve blocks in this patient population supports both studies.…”

Section: Discussionmentioning

confidence: 99%

“…While opioids have traditionally been the mainstay of postoperative pain‐control therapy, the significantly associated side effects and the rise of the national opioid epidemic has created an emphasis on treatment plans that minimize opioid use. Protocols that utilize multimodal pain therapies, such as regional nerve blocks, have shown improved perioperative pain control for a number of cardiac and thoracic procedures …”

Section: Introductionmentioning

confidence: 99%

“…Protocols that utilize multimodal pain therapies, such as regional nerve blocks, have shown improved perioperative pain control for a number of cardiac and thoracic procedures. [10][11][12][13] In this study, we aim to determine if the use of postoperative ultrasound-guided regional nerve blocks as part of the pain management regiment after CSS LVAD implantation decreases postoperative patient-reported pain scores or opioid use.…”

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confidence: 99%

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Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

et al. 2019

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Background Less‐invasive techniques for left ventricular assist device (LVAD) implantation have shown promising outcomes but are associated with significant postoperative pain. We aim to investigate the use of ultrasound‐guided regional nerve blocks to improve pain management during these procedures. Methods We retrospectively reviewed patients implanted with a HeartMate 3 LVAD via complete sternal‐sparing (CSS) approach at our institution from February 2018 to July 2018. Patients were grouped based on their postoperative pain management plan—those who received a regional nerve block plus multimodal analgesia and a control group who received standard multimodal analgesia alone. Pain scores and analgesic use were recorded for all patients during the initial 72 hours postoperatively. Results Preoperative characteristics were similar between cohorts. Of the 28 patients included in the study, 15 (54%) received a postoperative regional nerve block. Patients who received a nerve block had significantly lower pain scores and required a lower dose of opioid analgesics (70.7 ± 13.9 vs 124.6 ± 19.3 morphine equivalents, P = 0.029) during the first 72 hours postoperatively. There was no difference in time to extubation, intensive care unit length of stay, or hospital length of stay. Conclusions Optimizing postoperative analgesia using a regional nerve block is associated with decreased opioid use and decreased postoperative pain after CSS LVAD implantation. Regional nerve blocks should be included as part of a protocol‐based postoperative pain management program.

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“…Literatürdeki meme cerrahilerinde analjezik amaçlı SPB uygulanan randomize kontrollü çalışmalar incelendiğinde, tek başına SPB uygulanan çok az sayıda çalışma bulunmaktadır (16) . SPB, yalnızca meme cerrahilerinde değil aynı zamanda torakoskopik (17,18) ve kardiyak cerrahilerde (19) de yeter-li analjezi sağladığına dair çeşitli çalışmalarda mevcuttur. Torakoskopik sempatektomi (20) olgularında uygulanan SPB yeterli analjezik etkinlik oluşturduğu ve video aracılı torasik cerrahi olgularında SPB uygulanan 90 hastalık bir çalışmada, 2 gün boyunca yeterli analjezik etkinlik olduğu gösterilmiştir (21) .…”

Section: Gereç Ve Yöntemunclassified

The Effect of Ultrasound Guided Superficial Serratus Plane Block For Acute Post mastectomy Pain After Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Randomized Controlled Study

Yayık¹,

Ahişkalıoğlu²,

Sulak³

et al. 2019

JARSS

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Meme kanseri kadınları etkileyen en yaygın kanser türüdür. Her yıl binlerce hasta meme ve aksiller bölgeden cerrahi geçirmektedir. Bu cerrahi sırasında çok ciddi akut postoperatif ağrı meydana gelmektedir. Ultrasonografini kullanımının son yıllarda rejyonal anestezi pratiğinde artmasıyla birlikte plan blokları da oldukça popüler hale gelmiştir. Bunlardan birisi de serratus kasının üzerine veya altına lokal anestezik yayılımı ile tanımlanan serratus plane bloğudur (SPB). Bu çalışmanın amacı, meme kanseri nedeniyle modifiye radikal mastektomi ve lenf nodu diseksiyonu yapılacak hastalarda yüzeyel SPB'nun postoperatif opioid tüketimine etkisini araştırmaktır. Yöntem: Etik onam alındıktan sonra 18-65 yaş arası, ASA I-III modifiye radikal mastektomi ve aksiller lenf nodu diseksiyonu yapılacak olan 48 hasta randomize olarak serratus blok (grup SPB, n=24) veya kontrol grubu (grup K, n=24) olarak 2 gruba ayrıldı. SPB grubuna ultrasound eşliğinde 30 mL %0.25'lik bupivakain serratus kası üzerine SPB uygulandı. Grup K'ya ise ultrasound eşliğinde 2 mL salin subkutan cerrahi öncesi uygulandı. Postoperatif dönemde 12 saatte bir 50 mg deksketoprofen trometamol ve intravenöz fentanil ile hasta kontrollü analjezi düzenlendi. Aktif ve pasif visual analog skala (VAS) ile postoperatif analjezi değerlendirildi. Opioid tüketimi, ek analjezi gereksinimi ve opioid ile ilişkili yan etkiler ilk 24 saatte kaydedildi. Bulgular: SPB grubu 24 saatlik fentanil tüketimi açısından kontrol grubundan anlamlı olarak daha düşük bulunmuştur (123.96±72.04 vs 345.83±207.56 sırasıyla p<0.001). Hastaların postoperatif tüm ölçüm zamanlarında VAS değerleri Grup SPB'de kontrol grubuna göre anlamlı derecede düşüktü (p<0.05). Ek analjezik gereksinimi; Grup SPB'de kontrol grubuna göre anlamlı derecede düşüktü (3/24 vs 9/24 sırasıyla p=0.046). Sonuç: Yüzeyel SPB; modifiye radikal mastektomi ve lenf nodu diseksiyonu cerrahisinde kolay uygulanabilir olması, kusursuz bir analjezi sağlaması ve opioid tüketimini azaltmasıyla postoperatif ağrı yönetimi için güvenle kullanılabilir.

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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

Cited by 97 publications

References 22 publications

Ultrasound‐guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic‐assisted thoracic surgery

Ultrasound‐guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic‐assisted thoracic surgery

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

The Effect of Ultrasound Guided Superficial Serratus Plane Block For Acute Post mastectomy Pain After Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Randomized Controlled Study

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