Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Beard, Laura; Hillermann, C.; Beard, Emma; Millerchip, Sue; Sachdeva, Rajneesh; Smith, Fang Gao; Veenith, Tonny

doi:10.1136/rapm-2019-101119

Cited by 34 publications

(31 citation statements)

References 25 publications

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“…There were five studies comparing serratus anterior plane block with thoracic paravertebral blockade, four of which were in breast surgery. As with the PECS2 block in other metaanalyses [32,33,37], the serratus anterior plane block was equivalent to thoracic paravertebral blockade regarding almost all analgesic outcomes, except for higher pain scores in the immediate postoperative period (< 2 h) in the serratus anterior plane block group (mean difference 1.0, 95%CI 0.6-1.4, p < 0.001) [42].…”

Section: Anterolateral Chest Wall and Axillary Regionsupporting

confidence: 51%

“…There is evidence that a serratus anterior plane block alone, without the PECS1 component, can provide clinically useful chest wall analgesia. A recent meta-analysis reviewed 19 RCTs comparing serratus anterior plane block with either systemic analgesia alone or thoracic paravertebral blockade, in both breast (13 studies) and thoracic surgery (six studies) [42]. The addition of a serratus anterior plane block significantly reduced pain scores during the first 24 postoperative hours, with a mean difference ranging from 1.3-1.7 at 0-6 h (p < 0.001) to a more modest 0.7-0.9 (p < 0.001) at 12-24 h. Similar magnitudes of effect were seen on sub-group analyses of breast vs. thoracic surgery, superficial vs. deep serratus anterior plane block and studies at low risk of bias.…”

Section: Anterolateral Chest Wall and Axillary Regionmentioning

confidence: 99%

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Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

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Section: Anterolateral Chest Wall and Axillary Regionsupporting

confidence: 51%

Section: Anterolateral Chest Wall and Axillary Regionmentioning

confidence: 99%

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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“…6 SAPB was suggested to be easy and safe procedure because of the superficial position of the target point that doesn't involve any major vessels. 6 It has been reported to provide efficient analgesia in many different trials such as; in patients with multiple rib fracture compared to TEA and PVB [11] , in breast cancer surgeries [12] and minimal invasive heart surgeries .13 Previous trials were conducted to evaluate the effect of SAPB compared to the TEA in thoracic surgeries. 14, 15,16,17 This study aimed to evaluate the effect of SSPB, DSPB and TEA in thoracotomies in patients with lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

Abdelrahman¹,

Wasseef²,

Hassan³

et al. 2021

Anaesth. pain intensive care

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Background & objective: The serratus anterior plane block (SAPB) is a recent technique providing effective perioperative analgesia in thoracic surgeries. This study compared the intra–operative hemodynamics and the perioperative analgesic efficacy of superficial SAPB, to deep SAPB, and to thoracic epidural analgesia in thoracotomies. Methodology: one hundred and eighty lung cancer patients scheduled for thoracotomy were randomly allocated to three groups; TEA group, which received thoracic epidural analgesia, SSPB group receiving ultrasound–guided superficial serratus plane block and DSPB group which received US–guided deep serratus plane block. Baseline and intra–operative hemodynamics and total consumption of intraoperative fentanyl and postoperative morphine was noted. Results: Intra–operative mean arterial pressure (MAP) significantly decreased in the TEA group compared to baseline values, whereas no significant changes were found in either SSPB or DSPB groups. Heart rate (HR) did not show significant changes in any group. The time to postoperative analgesic demand was significantly longer in the SSPB and DSPB groups than in the TEA group (p < 0.001). In the first postoperative hour, TEA group had significantly higher visual analogue scale (VAS) scores than SSPB or DSPB groups at rest and with cough. The total consumption of intraoperative fentanyl and postoperative morphine was comparable among all groups. Conclusion: Pre–operative SSPB and DSPB can provide adequate perioperative analgesia without hemodynamic instability when compared to TEA in thoracotomies. Key words: Deep serratus plane block; Superficial serratus plane block; Thoracic epidural analgesia; Analgesia; Thoracotomy Trial registration: The trial was registered at ClinicalTrials.gov with registration number (NCT 04189120). https://clinicaltrials.gov/ct2/show/NCT04189120 Citation: Abdelrahman AS, Al Wasseef MM, Hassan ME, Abdelghafar EM. Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial. Anaesth. pain intensive care 2021;25(6):713–721; DOI: 10.35975/apic.v25i6.1690

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“…There were several case reports and series which were identified on literature search. Papers in which SAPB was performed in critically ill patients with multiple injuries were not analyzed as they did not fulfill the inclusion criteria [18,19].…”

Section: Study Characteristicsmentioning

confidence: 99%

Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review

Nair¹,

Diwan²

2022

Cureus

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Ultrasound (US) guided serratus anterior plane block (SAPB) is a fascial plane block that has been utilized for managing pain after thoracotomy, mastectomy, and fractured ribs. We conducted this qualitative review to investigate the analgesic efficacy of US-guided SAPB in patients who sustained multiple rib fractures (MRFs).We registered our review proposal in a prospective register of systematic reviews, PROSPERO, with identifier CRD42020177145. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the identification, screening, and inclusion of relevant articles. Two authors independently searched Pubmed, Embase, the Cochrane Library, Google Scholar, and Web of Science to identify available randomized controlled trials (RCT), case reports, case series reports where SAPB was used for managing pain due to MRFs.Out of the 66 articles identified by the search strategy, 23 articles were assessed for eligibility, and 16 articles were included in the qualitative review. Due to significant heterogenicity, the presence of only one RCT, the presence of case report or series, availability of only retrospective studies for review, a quantitative analysis using statistical tests were not done. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was not done as there was only one RCT in the review which had limitations like allocation concealment and blinding. US-guided SAPB is a safe and effective fascial plane block for managing pain in patients who sustain MRFs. Further research in the form of well-designed and adequately powered RCTs is needed to confirm its use in patients with MRFs.

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Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Cited by 34 publications

References 25 publications

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Evaluating the effect of ultrasound–guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Managing Pain Due to Multiple Rib Fractures: A Scoping Review

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