Comparison of the postoperative analgesic efficacy of serratus anterior plane block with different types of blocks for video-assisted thoracoscopic surgery: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The study aimed to compare the analgesic efficacy of single-shot serratus anterior plane block (SAPB) for video-assisted thoracoscopic surgery (VATS) with other regional block techniques.

METHODS

In this meta-analysis, randomized controlled trials published in the PubMed, Scopus, Web of Science, ClinicalKey, and PROSPERO electronic databases between March 24, 2014 and March 24, 2024 comparing the analgesic efficacy of SABP with other regional blocks in adult patients undergoing VATS were reviewed.

RESULTS

Nine randomized controlled trials consisting of a total of 537 participants (287 males, 250 females; mean age: 55.2±13.1 years) were included in this meta-analysis. Serratus anterior plane block was compared with erector spinae plane block (ESPB), local infiltration anesthesia (LIA), and thoracic paravertebral block (TPVB). The postoperative 24-h cumulative opioid consumption was statistically significantly higher in SAPB than in ESPB (standardized mean difference [SMD]=1.98; 95% confidence interval [CI], 0.23 to 3.73; Z=2.22; p=0.03; I 2 =97%; random effects model) and TPVB (SMD=0.63; 95% CI, 0.31 to 0.96; Z=3.84; p<0.001; I 2 =0%; fixed effects model) and lower than in LIA (SMD=-1.77; 95% CI, -2.24 to -1.30; Z=7.41; p<0.001; I 2 =0%; fixed effects model). Active pain scores 2 h postoperatively were statistically significantly lower in SAPB than in LIA (SMD=-2.90; 95% CI, -5.29 to -0.50; Z=2.37; p=0.02; I 2 =93%; random-effects model). At 12 h postoperatively, both passive pain scores (SMD=0.37; 95% CI, 0.07 to 0.66; Z=2.41; p=0.02; I 2 =0%; fixed effects model) and active pain scores (SMD=0.55; 95% CI, 0.25 to 0.85; Z=3.60; p<0.001; I 2 =0%; fixed effects model) were statistically significantly lower in ESBP than in SAPB. There was no difference between SAPB and the other groups in terms of the incidence of postoperative nausea and vomiting.

CONCLUSION

After a comprehensive evaluation of postoperative analgesic effects, it appears that ESBP and TPVB may be better than SABP, and SABP may be better than LIA for analgesia of patients undergoing VATS. Further studies are required to determine the optimal regional analgesia technique in VATS.

Treatment of pulmonary hydatid cysts: a single-centre analysis of 872 cases

OBJECTIVES

The objective of this study was to investigate the importance of pulmonary parenchyma preservation, the results of cystotomy and the capitonnage technique and the efficacy of postoperative albendazole treatment.

METHODS

A retrospective study was conducted at a single centre between 2000 and 2024, encompassing 872 consecutive patients with pulmonary hydatid cysts.

RESULTS

Of the cases studied, 394 (45.2%) were female and 478 (54.8%) were male, with a mean age of 26.8 ± 19.7 years (range: 2-86 years). Isolated lung involvement was observed in 553 (63.4%) cases. In general, a single hydatid cyst was detected in 665 (76.3%) patients, and 466 (53.4%) of these had isolated lung involvement. In 452 cases (51.8%), only the right lung was affected, whereas 294 (33.7%) had left lung involvement, and 126 (14.5%) had bilateral lung involvement. An operation was performed in 807 (92.5%) cases. Cystotomy and capitonnage were performed in 782 (89.7%) patients. Thoracoscopic wedge resection was performed in 13 cases (1.5%), cystotomy alone in 5 cases (0.6%), lobectomy in 5 cases (0.6%) and enucleation with capitonnage in 2 cases (0.2%). Postoperative complications included atelectasis in 45 cases (5.6%), prolonged air leak in 8 cases (1.0%), empyema in 6 cases (0.7%), wound infection in 3 cases (0.4%) and bleeding in 2 cases (0.2%). Recurrence was observed in 4 (0.5%) surgically treated cases, and 1 case (0.1%) resulted in death in the postoperative period.

CONCLUSIONS

The management of pulmonary hydatid cysts with cystotomy and capitonnage is feasible in the majority of patients and results in acceptable success and complication rates. Administration of albendazole postoperatively has been shown to be an effective method of preventing recurrence.