Serratus anterior plane block for video-assisted thoracoscopic surgery

Abstract

BACKGROUND The serratus anterior plane block (SAPb) is a promising interfascial plane technique able to provide profound thoracic analgesia. As only a few studies with quite small patient samples are presently available, the analgesic efficacy of adding SAPb to general anaesthesia in video-assisted thoracoscopic surgery (VATS), compared with general anaesthesia only, remains unclear. OBJECTIVES Our primary aim was to assess the analgesic efficacy of SAPb for VATS peri-operative pain control. The secondary aims were to evaluate differences in postoperative opioid use, intra-operative hypotension, postoperative side-effects and complications, time to chest tube removal, length of hospital stay. DESIGN Systematic review of randomised controlled trials (RCTs) with meta-analyses. DATA SOURCES PubMed, Web of Science, Google Scholar and the Cochrane Library, searched up to 6 December 2019. ELIGIBILITY CRITERIA RCTs including adult patients undergoing VATS who received single shot SAPb (cases), compared with general anaesthesia (controls). RESULTS Seven RCTs, with a total of 489 patients were included. SAPb reduced pain scores peri-operatively, compared with controls: 6 h [mean difference −1.86, 95% confidence interval (CI) −2.35 to −1.37, P < 0.001]; 12 h (mean difference −1.45, 95% CI −1.66 to −1.25, P < 0.001); 24 h (mean difference −0.98, 95% CI −1.40 to −0.56, P < 0.001). SAPb also reduced the use of postoperative opioids (mean difference: −4.81 mg of intravenous morphine equivalent, 95% CI −8.41 to −1.22, P < 0.03) and decreased the incidence of nausea and vomiting (risk ratio 0.53, 95% CI 0.36 to 0.79, P < 0.002). CONCLUSION Compared with general anaesthesia only and if no other locoregional techniques are used, SAPb significantly reduces postoperative pain and nausea and vomiting in patients undergoing VATS. Grading of Recommendations Assessment, Development and Evaluation rating are, nonetheless, quite low, due to high heterogeneity. Well designed and properly powered RCTs are necessary to confirm these preliminary findings.

Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study

“…The outcomes of the SAPB may differ depending on the type, volume, concentration, and target point of the local anesthetic. In superficial or deep SAPB applications, 10-30 mL of 0.125%-0.375% ropivacaine or bupivacaine were administered and it was reported to provide adequate analgesia for rib fractures, VATS, thoracotomy, breast surgery [2,12,13]. In order to avoid the development of a winged scapula and local anesthetic systemic toxicity, we administered 20 mL of 0.25% bupivacaine by USG guidance to apply a deep SAPB.…”

“…In two meta-analyses investigating the analgesic efficacy of adding the SAPB to general anesthesia, the authors stated that combining the USG-guided SAPB with general anesthesia provides more effective postoperative analgesia in VATS [2,19]. They stated that combining the USGguided SAPB with general anesthesia provides more effective postoperative analgesia.…”

“…The serratus anterior plane block (SAPB) provides analgesia in the chest wall by blocking the lateral branches of the intercostal nerves, usually between the T2-T9 levels [2]. The paravertebral block (PVB) has been used for many years in the treatment of breast, thorax, and abdominal surgeries; rib fractures; and cancer pain [3].…”

Comparison of rhomboid intercostal nerve block, erector spinae plane block, and serratus plane block on analgesia for modified radical mastectomy: A prospective, randomized, controlled trial

“…Blanco et al reported for the first time that SAB block has a blocking effect on the intercostal nerve of T 2˜T9 and can provide chest wall and axillary regional anesthesia [9]. Previous studies have reported the effects of SAB blockers and placebos on opioid consumption in patients with breast cancer after modified radical mastectomy [13,14]. Recently, Yao et al [14]reported that pre-operative administration of SAB with ropivacaine improved the quality of recovery, postoperative analgesia, and patient satisfaction following breast cancer surgery, However, Fu jii et al [15] found that compared to SAB block, the PECS-2 block reduced chronic pain six months after MRM.…”

<p>Analgesic Effect of Serratus Anterior Plane Block After Thoracoscopic Surgery: A Randomized Controlled Double-Blinded Study</p>

“…A comparison of SAPB and local infiltration anesthesia for postoperative analgesia after VATS found that patients in the SAPB group had better VAS scores during the first 8 h postoperatively, and the dose of opioids in SAPB group was far lower. 28 A recent meta-analysis by De Cassai et al 29 on the analgesic effect of SAPB in patients undergoing thoracoscopic surgery showed that general anesthesia combined with SAPB reduced perioperative pain compared with general anesthesia alone. The analgesic score in the SAPB group at 6-, 12-, and 24 hrs after surgery was lower than that of the control group, but the analgesic effect at 6 hrs was better than that at 24 hrs.…”