Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial

Abstract

OBJECTIVES This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon’s direct vision for providing postoperative pain relief after thoracic surgeries. METHODS Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia (IVPCA)+continued RISS block; n = 20) and group C (IVPCA; n = 20). Numeric rating scale (NRS) at rest and cough, at post-anesthetic care unit, 1, 2, 6, 9, 12, 24, and 48 hours was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions, and the overall satisfaction with pain management. RESULTS NRS scores both at rest and during coughing were significantly lower in group R than the group C group at all time intervals (p < 0.001 in each). Tramadol consumption at 24 h and 48 h was significantly lower in the group R block than group C (p < 0.001 for each). None of the patients in group R require rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (p = 0.047 and p = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than group C (p < 0.001). CONCLUSION Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function, and patient satisfaction. Clinical trial registration NCT04443556 (https://clinicaltrials.gov/ct2/show/NCT04443556)

Analgesic effect of rhomboid intercostal block with sub serratus plane block versus thoracic erector Spinae block in multiple rib fractures: A randomized study

“…In the present study, total morphine consumption during the first 24 hours was significantly higher in ESPB group. In agreement with our results, Kozanhan et al [11] observed that tramadol consumption at 24 and 48 h was significantly lower in the RISS block group block. Supporting our findings, Okmen et al [17] showed that postoperative tramadol consumption at 24 h was lower in the RISS group .…”

“…Based on our findings, there was a statistically significant difference observed in the duration (measured in hours) before the first analgesic necessity between the ESPB group and the RISS group. Consistent with our findings, Kozanhan et al (11) observed that none of the patients in the RISS block group need the use of rescue analgesia. In a similar vein, Deng et al (7) observed that the duration until the first request for postoperative analgesics was shorter in the RISS group compared to the RIB group, specifically within 24 hours after the surgical procedure.…”

“…post block as compared to admission with insignificant difference between both groups at admission, 30 min, 6 hrs and 24 hrs post block. This result goes in hand with Kozanhan et al [11] Who carried out prospective, randomized controlled trial on forty patients who underwent thoracotomy and found that HR was significantly decreased after block compared to baseline levels in RISS block group. MAP in ESPB group and RISS group showed significant reduction at 30 min, 6 hrs, 12 hrs and 24 hrs post block as compared to admission with insignificant difference between both groups at the admission, 30 min, 6 hrs and 24 hrs post block.…”

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

“…Even if PVB-VATS seems to be effective, there are no sufficient data to definitively promote the technique . Kozanhan et al found a positive result for thoracoscopic vision regional block compared with no regional block after thoracotomy. Moreover, thoracoscopic-guided intercostal nerve block can be successfully performed for uniportal lobectomy .…”

The Shining Star of the Last Decade in Regional Anesthesia Part-I: Interfascial Plane Blocks for Breast, Thoracic, and Orthopedic Surgery

“… 37 - 39 For the thoracic region, its effectiveness has been demonstrated in VATS and multiple rib fractures in the lateral region. 40 - 43 A meta-analysis of studies that evaluated RIB and no block in patients undergoing breast and thoracic surgery showed that patients who underwent RIB had lower pain scores, opioid consumption, and PONV rates. 44 In another study comparing the efficacy of RISS, ESP, and SAPB in patients undergoing VATS, it was identified that the patients who underwent RIB and ESPBs had lower opioid consumption and dynamic pain scores in the first 24 hours postoperatively compared to SAPB.…”