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

Abstract

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.

<p>Operation, Effectiveness, and Limitations of Continuous Serratus Anterior Plane Blocks for Thoracoscopic Surgery in Adults</p>

“…Qiu et al 11 also confirmed asimilar effect of SAPB and PVB in terms of postoperative acute pain, additional analgesia, postoperative nausea and vomiting, pain assessment at rest and on coughing, without any significant difference. Hanley et al 12 found that continuous SAPB provided better postoperative 24-hour NRS assessment of rest pain, coughing pain, and movement pain, compared with continuous PVB. The results of our study show that cSAPB significantly relieved the pain of patients at rest, which is similar to the results of the previous studies.…”

<p>The Safety and Efficacy of Ultrasound-Guided Serratus Anterior Plane Block (SAPB) Combined with Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery (VATS): A Randomized Controlled Trial</p>

“…33 Hanley et al have shown that SAPB is a non-inferior regional anesthesia technique in terms of analgesic efficacy compared to PVB when incorporated within a multimodal analgesia regimen. 16 In our study, patients in the D2 group had a significantly lower VASr score (during the first 24 h after surgery) and opioid requirement after surgery; however, the prevalence of chronic pain and functional measures were similar between the two groups. Khalil et al reported that SAPB maintained hemodynamic stability compared with TEB and led to lower pain scores and less morphine consumption in the early postoperative period after thoracotomy, with no noteworthy complications.…”

“…All patients had a standardized postoperative multimodal analgesia regimen including 1 g oral paracetamol and 400 mg oral ibuprofen every 8 h based on the previous study. 16 If the visual analog scale for pain while coughing (VASc) score was ≥4, 2.5 µg intravenous sufentanil was given.…”

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

“…At the end of this study, they reported that SAPB blocks only the lateral cutaneous branches of the intercostal nerves; therefore, further studies are needed on the analgesic activity of SAPB. While studies on the activity of SAPB continue, Hanley et al 27 published a very recent study. In two groups of 20 patients who underwent VATS, they performed continuous deep SAPB on one group while performing continuous paravertebral block on the other; this study reported preferring deep SAPB as this avoids the need for a long thoracic nerve block.…”