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Li J, Wang X, Wang Y, Zhang W. Analgesic effectiveness of serratus anterior plane block in patients undergoing video-assisted thoracoscopic surgery: a systematic review and updated meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:235. [PMID: 37442948 PMCID: PMC10339549 DOI: 10.1186/s12871-023-02197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Serratus anterior plane block (SAPB) is a promising regional technique for analgesia in thoracic surgery. Till now, several randomized controlled trials (RCTs) have explored the effectiveness of SAPB for postoperative pain control in patients undergoing video-assisted thoracoscopic surgery (VATS), but the sample sizes were small and conclusions remained in controversy. Therefore, we conducted the present systematic review and meta-analysis. METHODS RCTs evaluating the analgesic performance of SAPB, comparing to control methods (no block, placebo or local infiltration anesthesia), in patients undergoing VATS were searched in PubMed, EMBASE, Web of Science and Cochrane Library from inception to December 31, 2022. Mean difference (MD) and corresponding 95% confidence interval (95%CI) were calculated for postoperative pain scores at various time points, postoperative opioid consumption and length of hospital stay. Pooled relative risk (RR) with 95%CI were calculated for the risk of postoperative nausea and vomiting (PONV) and dizziness. A random-effect model was applied. RESULTS A total of 12 RCTs (837 participants) were finally included. Compared to control group, SAPB had significant reductions of postoperative pain scores at 2 h (MD = -1.58, 95%CI: -1.86 to -1.31, P < 0.001), 6 h (MD = -2.06, 95%CI: -2.74 to -1.38, P < 0.001), 12 h (MD = -1.72, 95%CI: -2.30 to -1.14, P < 0.001) and 24 h (MD = -1.03, 95%CI: -1.55 to -0.52, P < 0.001), respectively. Moreover, SAPB conferred a fewer postoperative opioid consumption (MD = -7.3 mg of intravenous morphine equivalent, 95%CI: -10.16 to -4.44, P < 0.001) and lower incidence of PONV (RR = 0.56, 95%CI: 0.41 to 0.77, P < 0.001). There was no difference between both groups regarding length of hospital stay and risk of dizziness. CONCLUSION SAPB shows an excellent performance in postoperative pain management in patients undergoing VATS by reducing pains scores, postoperative opioid consumption and incidence of PONV. However, due to huge heterogeneity, more well-designed, large-scale RCTs are needed to verify these findings in the future.
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Affiliation(s)
- Jie Li
- Department of Anesthesiology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, 044000, Shanxi Province, China
| | - Xiaoyu Wang
- Department of Anesthesiology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, 044000, Shanxi Province, China
| | - Yinge Wang
- Department of Anesthesiology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, 044000, Shanxi Province, China
| | - Wenwu Zhang
- Department of Anesthesiology, Yuncheng Central Hospital, Shanxi Medical University, Yuncheng, 044000, Shanxi Province, China.
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Zhang W, Cong X, Zhang L, Sun M, Li B, Geng H, Gu J, Zhang J. Effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery. Clin Transl Med 2020; 10:e38. [PMID: 32639645 PMCID: PMC7418816 DOI: 10.1002/ctm2.38] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background To investigate the effects of thoracic nerve block on perioperative lung injury, immune function, and recovery after thoracic surgery Methods A total of 120 patients with lung cancer were randomly allocated into three groups: general anesthesia group (GAL group), thoracic paravertebral nerve block (TPVB) combined with general anesthesia (TPL group), and TPVB (with paravertebral dexmedetomidine) combined with general anesthesia group (TDL group); 120 patients with esophageal cancer were randomly allocated into three groups: general anesthesia group (GAE group), TPVB combined with general anesthesia group (TPE group), and thoracic epidural block combined with general anesthesia group (TEE group). Lung injury and immune function were evaluated. Hemodynamic changes, early recovery in post‐anesthesia care unit, pain, 6‐min walking test (6MWT), drug consumption, and life quality were also observed. The duration in the PACU of patients was retrospectively analyzed. The effect of dexmedetomidine on lung injury was established in vitro. Results The lung injury, including injury scores, apoptosis, and inflammation, were decreased in the TDL group compared with the GAL group and TPL group. The ratio of CD4+/CD8+ cells at the end of surgery was higher in the TPE group than in the GAE group. More stable hemodynamic was found in TPL group and TPE group. Acute pain was alleviated and the 6MWT was enhanced by TPVB with or without dexmedetomidine. Anesthetic consumption was decreased by thoracic nerve block. Conclusions Thoracic nerve block, especially TPVB with or without paravertebral dexmedetomidine, can enhance recovery after thoracic surgery. Protection against independent lung injury and cellular immune dysfunction may be a potential mechanism.
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Affiliation(s)
- Wei Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Xuhui Cong
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Liyuan Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Bing Li
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Hongfang Geng
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Jianqin Gu
- Department of General Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Center for Clinical Single Cell Biomedicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
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Liu X, Song T, Xu HY, Chen X, Yin P, Zhang J. The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled trails. Medicine (Baltimore) 2020; 99:e20286. [PMID: 32481308 PMCID: PMC7249988 DOI: 10.1097/md.0000000000020286] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The serratus anterior plane (SAP) block is a newer method that can be used in patients undergoing thoracic surgeries. The postoperative analgesia efficacy of SAP blocks for thoracic surgery remains controversial. We conduct a meta-analysis to evaluate the analgesia of SAP blocks after thoracic surgery. METHODS We searched PubMed, Embase, EBSCO, the Cochrane Library, Web of Science, and CNKI for randomized controlled trials (RCTs) regarding the postoperative pain control of a SAP block on thoracic surgery. All of the dates were screened and evaluated by two researchers and meta-analysis was performed using RevMan5.3 software. RESULTS A total of 8 RCTs involving 542 patients were included. The meta-analysis showed statistically significant differences between the two groups with respect to postoperative pain scores at 2 h (standardized mean difference [Std.MD] = -1.26; 95% confidence interval [CI] = -1.66 to -0.86; P < .0001); 6 h (SMD = -0.50; 95%CI = -0.88 to -0.11; P = .01); 12 h (SMD = -0.63; 95%CI = -1.10 to -0.16; P = .009); 24 h (SMD = -0.99; 95%CI = -1.44 to -0.51; P < .0001); postoperative opioid consumption at 24 h (SMD = -0.83; 95%CI = -1.10 to -0.56; P < .00001); and postoperative nausea and vomiting (PONV) rates (RR = 0.39; 95% CI = 0.21-0.73; P = .003). CONCLUSION The SAP block can play an important role in the management of pain after thoracic surgery by reducing both pain scores and 24-h postoperative opioids consumption. In addition, there is fewer incidence of PONV in the SAP block group.
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Affiliation(s)
- Xiancun Liu
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin
| | - Tingting Song
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin
| | - Hai-Yang Xu
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin
| | - Xuejiao Chen
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing
| | - Pengfei Yin
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan
| | - Jingjing Zhang
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin, China
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El-Hag-Aly MA, Hagag MG, Allam HK. If post-thoracotomy pain is the target, Integrated Thoracotomy is the choice. Gen Thorac Cardiovasc Surg 2019; 67:955-961. [PMID: 30993532 DOI: 10.1007/s11748-019-01126-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Despite the overgrowth of procedures done by VATS, there are still needs for thoracotomy. Post-thoracotomy pain plays an important role in many post-operative morbidities. Surgeons should make efforts to evolve new techniques to reduce post-thoracotomy pain with its associated morbidities. This trial aimed to study the impact of combining lack of rib retraction with protection of both intercostal nerves on post-operative pain. METHODS This was a prospective study of 57 patients who had Integrated thoracotomy (I group) which consists of modified French window with Double-Edge closure. The results of I group were compared to our previous study that contained two groups 60 patients each, double edge (DE group) in which standard thoracotomy was closed using double-edge technique and (PC group) in which pericostal sutures was used for closure of thoracotomy. Outcomes assessed were operative time, time to ambulation, doses of analgesics injected in the epidural catheter, post-operative complications, chest tube drainage, hospital stay, and pain score and use of analgesics during the first post-operative year. RESULTS All groups had similar demographics, operative time, and incisions length, but in I group, there were significantly a smaller number of lobectomies and pneumonectomies. Patients in I group had significantly lower time to ambulation, epidural doses and post-operative pain score throughout the first week. Patients in the (I group) had a significantly lower pain score throughout the first 9 months post-operatively. Up to 6 months post-operatively, there was significantly less use of analgesics among the I group. CONCLUSION The combination of retractor-free exposures and neurovascular exclusion sutures for thoracotomy is safe and effective in decreasing post-thoracotomy pain and use of analgesics.
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Affiliation(s)
- Mohammed A El-Hag-Aly
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Yassin Abdel Ghaffar Street, 32511, Shebin El-Kom, Menoufia, Egypt.
| | - Mohamed G Hagag
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Yassin Abdel Ghaffar Street, 32511, Shebin El-Kom, Menoufia, Egypt
| | - Heba K Allam
- Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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Affiliation(s)
- Jimmy Holm
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Marchetti-Filho MA, Leão LEV, Costa-Junior ADS. The role of intercostal nerve preservation in acute pain control after thoracotomy. J Bras Pneumol 2014; 40:164-70. [PMID: 24831401 PMCID: PMC4083640 DOI: 10.1590/s1806-37132014000200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/26/2014] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE: To evaluate whether the acute pain experienced during in-hospital recovery from
thoracotomy can be effectively reduced by the use of intraoperative measures
(dissection of the neurovascular bundle prior to the positioning of the
Finochietto retractor and preservation of the intercostal nerve during closure).
METHODS: We selected 40 patients who were candidates for elective thoracotomy in the
Thoracic Surgery Department of the Federal University of São Paulo/Paulista School
of Medicine, in the city of São Paulo, Brazil. The patients were randomized into
two groups: conventional thoracotomy (CT, n = 20) and neurovascular bundle
preservation (NBP, n = 20). All of the patients underwent thoracic epidural
anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a
visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring
patient requests for/consumption of analgesics. RESULTS: On postoperative day 5, the self-reported pain intensity was significantly lower
in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p
= 0.04). No significant differences were found between the groups regarding the
number of requests for/consumption of analgesics. CONCLUSIONS: In patients undergoing thoracotomy, protecting the neurovascular bundle prior to
positioning the retractor and preserving the intercostal nerve during closure can
minimize pain during in-hospital recovery.
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Affiliation(s)
| | - Luiz Eduardo Villaça Leão
- Department of Thoracic Surgery, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Fortier MA, Chou J, Maurer EL, Kain ZN. Acute to chronic postoperative pain in children: preliminary findings. J Pediatr Surg 2011; 46:1700-5. [PMID: 21929977 DOI: 10.1016/j.jpedsurg.2011.03.074] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 02/22/2011] [Accepted: 03/22/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND/PURPOSE Chronic postoperative pain is a well-established clinical phenomenon that is associated with adverse outcomes. The incidence of this clinical phenomenon in children, however, is not well established. The purpose of this study was to identify the incidence of chronic pain in children after surgery. METHODS Following a screening process, a total of 113 children and their parents were enrolled in this cross-sectional study. Data regarding persistence and characteristics of pain after surgery were obtained. RESULTS Approximately 13% of the children, most of whom underwent orthopedic procedures, reported the existence of symptoms of chronic postoperative pain. Most of the children indicated that the pain started immediately after surgery, was localized to the surgery site, and was intermittent. Children reported a median duration of pain of 4.1 months, and approximately half of the children experienced pain most days of the week. Up to 30% of the children reported interference of pain in functioning in areas such as extracurricular activities and sleep. DISCUSSION Given the large number of children at risk for experiencing chronic postoperative pain, preventative efforts are necessary. Large-scale cohort prospective studies are needed to confirm the results of this cross-sectional study.
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Affiliation(s)
- Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Orange, CA 92868, USA.
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Lee W, Yan YY, Jensen MP, Shun SC, Lin YK, Tsai TP, Lai YH. Predictors and Patterns of Chronic Pain Three Months after Cardiac Surgery in Taiwan. PAIN MEDICINE 2010; 11:1849-58. [DOI: 10.1111/j.1526-4637.2010.00976.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Intercostal Muscle Flap for Decreasing Pain After Thoracotomy: A Prospective Randomized Trial. Ann Thorac Surg 2010; 89:195-9. [DOI: 10.1016/j.athoracsur.2009.07.094] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/29/2009] [Accepted: 07/30/2009] [Indexed: 11/20/2022]
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Rama-Maceiras P, Ingelmo II, Fàbregas JN, Hernández-Palazón J. [Fraudulent pain research: a hurt so deep nothing can alleviate it]. ACTA ACUST UNITED AC 2009; 56:372-9. [PMID: 19725345 DOI: 10.1016/s0034-9356(09)70410-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Untruthfulness in research is reprehensible. Dr Scott S. Reuben, an anesthesiologist at Baystate Medical Center in Springfield, Massachusetts in the United States, a leader and pioneer in the field of multimodal analgesia, has been accused of fraud, specifically of having falsified results in at least 21 manuscripts published over a period of 15 years. This may come to be seen as one of the largest-scale and longest-running acts of medical research fraud ever. Apart from fabricated data, it seems the author committed other acts of misconduct. His coauthors have not been accused of wrongdoing, as they allege their names were falsely appended to the manuscript. The editors of the 2 most implicated journals, Anesthesiology and Anesthesia & Analgesia, have published editorials retracting the papers they judge to be fraudulent. Because Dr Reuben is a major figure in postoperative multimodal analgesia, many studies by other authors whose hypotheses have emerged from findings announced in the discredited papers may also now be considered contaminated by association. The definitions of scientific misconduct and the procedures for pursuing offenders vary greatly from country to country, creating a certain degree of uncertainty about how to proceed when we confront this problem. Beyond any possible legal liability that might arise, there are the questions of how fraud might affect patients' health or the medical knowledge base. Although the concept of multimodal analgesia may continue to be defended, we cannot be absolutely sure of its benefits without carrying out new clinical trials to repair the damage done by this act of misconduct.
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Affiliation(s)
- P Rama-Maceiras
- Sección de Neurociencia de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Complejo Hospitalario Universitario A Coruña, Madrid.
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