The Effect of Preoperative Serratus Anterior Muscle Plane Block on Persistent Postsurgical Pain After Video-assisted Thoracic Surgery

Abstract

Objectives: Acute pain intensity is a strong indicator for the occurrence of persistent postsurgical pain (PPP) after video-assisted thoracic surgery (VATS). The effect of preoperative serratus anterior muscle plane block (SAPB) on PPP was investigated. Materials and Methods:In this retrospective cohort study, data of 148 patients who underwent VATS for lung nodules in 2019 were collected. Seventy-four patients received a single-shot of SAPB with 0.33% ropivacaine 30 mL after anesthesia induction and another 74 patients received intercostal blocks using 1% ropivacaine 10 mL at the fifth to seventh intercostal spaces after surgery. Postoperative analgesia was accomplished by continuous infusion of flurbiprofen (8 mg/h), and intravenous oxycodone rescue (1 mg) given on demand. Pain intensity was recorded at 24 and 48 hours after surgery and all patients were followed up 3 months after surgery investigating the occurrence of PPP.Results: Intraoperative sufentanil in the SAPB group was significantly decreased in comparison with Control group (0.34 ± 0.09 vs. 0.43 ± 0.14 ug/kg, P < 0.001). The incidence of PPP was comparable between 2 groups (20.2% [15/74] vs. 14.8% [11/74], P = 0.078). All patients who experienced PPP rated their PPP as mild, except 1 patient in Control group rated her pain as moderate. Multivariate logistic regression showed that pain score at 24 hours (odds ratio 1.646, 95% confidence interval [1.058, 2.560], P = 0.027) and female (odds ratio 3.711, 95% confidence interval [1.274, 10.810], P = 0.026) were independent risk factors for the development of PPP.Discussion: When SAPB was combined with continuous infusion of nonsteroidal anti-inflammatory drugs, no patient had moderate chronic pain. Pain score at 24 hours after surgery and female were risk factors for PPP after VATS.

Prevalence and Predictors of Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis

“…Thereafter, 183 records were carefully reviewed to ensure compliance with the inclusion criteria. Ultimately, 17 studies [10][11][12][20][21][22][23][24][25][26][27][28][29][30][31][32][33], comprising 10,525 patients who underwent VATS, were included in this study (Fig. 1).…”

Prognostic factors for chronic post‐surgical pain after lung and pleural surgery: a systematic review with meta‐analysis, meta‐regression and trial sequential analysis

“…After removal of 166 records, 56 that met the eligibility criteria were included (Fig. 1) [9, 11, 50–103]. Of the 56 included studies, 28 (50%) were randomised controlled trials, 16 (29%) prospective observational studies and 12 (21%) retrospective observational studies.…”

Nomogram prediction of chronic postsurgical pain in patients with lung adenocarcinoma after video-assisted thoracoscopic surgery: A prospective study

“…In recent years, a number of retrospective studies have investigated the associated risk factors for the development of CPSP after VATS, including body mass index (BMI), history of pain, and acute postoperative pain (13,14,(16)(17)(18)(19). Further, studies have indicated that microRNAs (miRNAs) in the peripheral blood of patients with chronic neuropathic pain are closely associated with chronic neuropathic pain (20-22).…”

“…History of chronic pain refers to the baseline level of pain preoperatively, and retrospective studies have demonstrated that preoperative pain increases the risk of the development of CPSP ( 14 ). In addition to preoperative pain, postoperative VAS pain scores on days 1–3 were also positively associated with the occurrence of CPSP after VATS ( 17 ). There have been an increasing number of studies implicating miRNAs in their involvement in the occurrence and maintenance of pain, such as the small molecule miR 550a-3p, although its involvement in CPSP has not been confirmed ( 25 ).…”