1
|
Punzo G, Nachira D, Calabrese G, Cambise C, Congedo MT, Vita ML, Meacci E, Margaritora S. Safety and efficacy of surgically performed continuous superficial serratus anterior plane block in uniportal video-assisted thoracic surgery. J Minim Access Surg 2024:01413045-990000000-00076. [PMID: 39095997 DOI: 10.4103/jmas.jmas_345_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 06/03/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The 'surgically performed' continuous superficial serratus anterior plane block (continuous s-SAPB) was never described before in uniportal video-assisted thoracic surgery (uniportal VATS) surgery. The aim of the study was to evaluate the safety and efficacy of the technique. PATIENTS AND METHODS Between March 2022 and April 2023, 50 patients, undergone uniportal VATS surgery at our thoracic surgery department, were scheduled for a surgically performed continuous s-SAPB as post-operative analgesia protocol. RESULTS The mean execution time for the block was 3.92 ± 2.56 min. Ten patients (20%) required morphine for a visual analogue scale (VAS) score >4 immediately after surgery. The recorded VAS score at chest tube removal was 1.87 ± 1.41, whereas 2 h after the manoeuvre was 0.42 ± 0.72. No complication related to block insertion was recorded. The onset of chronic pain was observed in a total of 2 patients (4%). CONCLUSIONS The surgically performed continuous s-SAPB in uniportal VATS seems to be safe and easy to perform, and it provides a satisfactory analgesic effect.
Collapse
Affiliation(s)
- Giovanni Punzo
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Cambise
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Serra S, Santonastaso DP, Romano G, Riccardi A, Nigra SG, Russo E, Angelini M, Agnoletti V, Guarino M, Cimmino CS, Spampinato MD, Francesconi R, Iaco FD. Efficacy and safety of the serratus anterior plane block (SAP block) for pain management in patients with multiple rib fractures in the emergency department: a retrospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02597-6. [PMID: 39020130 DOI: 10.1007/s00068-024-02597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE Chest trauma is a severe and frequent cause of admission to the emergency department (ED). The serratus anterior plane (SAP) block seems to be an effective method of pain management; however, data on efficacy and safety of a single SAP block performed in the ED by emergency physicians (EP) are limited. This study aimed to compare SAP block performed by the EP in the ED plus standard therapy to standard therapy alone in terms of pain severity at 0-3-6-12-18 and 24 h, total opioid consumption (milligrams of morphine equivalents, MME), respiratory function (SpO2/FiO2 ratio), and adverse events (i.e. pneumothorax, infections in the site of injection, or Local Anaesthetic Systemic Toxicity syndrome due to SAP block) in the first 24 h. METHODS This retrospective, monocentric study included adult patients admitted to the Sub-intensive Care Unit (SICU) of the ED with multiple rib fractures between 01/2022 and 03/2023. RESULTS 156 patients (65.4% male; median age 62 years; median injury severity score 16; median thoracic trauma severity score 8) were included. 75 (48.2%) underwent SAP block. Patients undergoing SAP block showed significantly less pain 3-6-18 h after a single block, required less MME (0 [0-20] vs. 20 [0-40], p < 0.001), showed higher SpO2/FiO2 ratio, and no adverse events were reported. CONCLUSION The SAP block, in combination with standard therapy, appeared to be more effective in providing pain relief than standard therapy alone in patients admitted to the SICU for traumatic rib fractures.
Collapse
Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | | | - Giuseppe Romano
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Alessandro Riccardi
- SC Pronto Soccorso e Medicina d'Urgenza, Ospedale Santa Corona, Pietra Ligure, Savona, 17027, Italy
| | | | - Emanuele Russo
- Anestesia and Intensive Care Unit, Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Mario Angelini
- Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Vanni Agnoletti
- Anestesia and Intensive Care Unit, Emergency Department, Maurizio Bufalini Hospital, Cesena, 47521, Italy
| | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, Napoli, 80131, Italy
| | | | - Michele Domenico Spampinato
- Department of Translational Medicine and for Romagna, University of Ferrara, Via A. Moro 8, Ferrara, 44124, Italy.
| | - Raffella Francesconi
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, Torino, 10144, Italy
| | - Fabio De Iaco
- Department of Translational Medicine and for Romagna, University of Ferrara, Via A. Moro 8, Ferrara, 44124, Italy
| |
Collapse
|
3
|
Jeong YH, Moon DH, Lee S. Commentary: Exploring the Potential of Serratus Anterior Plane Block for Severe Pain Management after the Nuss Operation: Is It the Optimal Solution? J Chest Surg 2024; 57:300-301. [PMID: 38695116 PMCID: PMC11089059 DOI: 10.5090/jcs.24.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/15/2024] Open
Affiliation(s)
- Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Nachira D, Punzo G, Calabrese G, Sessa F, Congedo MT, Beccia G, Aceto P, Kuzmych K, Cambise C, Sassorossi C, Nocera A, Senatore A, Vita ML, Meacci E, Sollazzi L, Margaritora S. The Efficacy of Continuous Serratus Anterior and Erector Spinae Plane Blocks vs Intercostal Nerve Block in Uniportal-Vats Surgery: A Propensity-Matched Prospective Trial. J Clin Med 2024; 13:606. [PMID: 38276112 PMCID: PMC10816358 DOI: 10.3390/jcm13020606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND To evaluate the analgesic efficacy of continuous erector spinae plane block(c-ESPB) and serratus anterior plane block(c-SAPB) versus the intercostal nerve block (ICNB) in Uniportal-VATS in terms of pain control, drug consumption, and complications. METHODS Ninety-three consecutive patients, undergone one of the three peripheral nerve blocks after Uniportal-VATS, were prospectively enrolled. A 1:1 propensity score matching was used to minimize bias. RESULTS C-ESPB and c-SAPB groups had no difference in morphine request upon awakening compared to ICNB. A higher VAS-score was recorded in c-ESPB compared to ICNB in the first 12 h after surgery. A significantly lower consumption of paracetamol in II postoperative day (p.o.d.) and tramadol in I and II p.o.d. was recorded in the c-ESPB group compared to the ICNB group. A higher dynamic VAS score was recorded at 24 h and 48 h in the ICNB group compared to the c-SAPB. No difference was found in safety, VAS-score and drug consumption between c-ESPB and c-SAPB at any given time, except for a higher tramadol request in c-SAPB in II p.o.d. CONCLUSIONS C-ESPB and c-SAPB appear to have the same safety and analgesic efficacy when compared between them and to ICNB in Uniportal-VATS approach. C-ESPB showed a delayed onset of analgesic effect and a lower postoperative drug consumption compared to ICNB.
Collapse
Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Giovanni Punzo
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Flaminio Sessa
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Giovanna Beccia
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Paola Aceto
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Khrystyna Kuzmych
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Chiara Cambise
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Carolina Sassorossi
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Adriana Nocera
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Alessia Senatore
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| | - Liliana Sollazzi
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.P.); (G.B.); (P.A.); (C.C.); (L.S.)
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy (M.T.C.); (K.K.); (C.S.); (A.N.); (S.M.)
| |
Collapse
|
5
|
He K, Meng Y, Zhu Y, Wang S, Zong Y. Comparing Continuous and Intermittent Infusion Effects on Serratus Anterior Plane Blocks in Video-Assisted Thoracoscopic Surgery: A Randomized Clinical Trial. J Pain Res 2023; 16:4015-4024. [PMID: 38026459 PMCID: PMC10676657 DOI: 10.2147/jpr.s431453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The programmed intermittent bolus infusion (PIBI) of local anesthetic produces wider sensory blockade and better analgesia than continuous infusion (CI). We designed this trial to compare the effects of these two different infusion methods combined with Serratus Anterior Plane Blocks (cSAPBs) on postoperative pain relief in patients undergoing video-assisted thoracoscopic surgery. Methods We randomly allocated 66 patients under going elective video-assisted thoracoscopic unilateral lung resection surgery to two groups (PIBI group and CI group, n=33 per group). After the surgical operation, the patients received ultrasound-guided ipsilateral SAPB, we randomized them to receive either automated intermittent boluses or continuous infusion of 0.3% ropivacaine. Tramadol consumption during the 48 hours following surgery was the primary outcome. Secondary outcomes included cumulative tramadol consumption during the first 24-h and the second 24-h periods after surgery, pain scores, patient satisfaction, blocked dermatomes, and adverse events. Results During 48h, tramadol consumption in the PIBI group was significantly lower than in the CI group (190 mg [125, 305] vs 220 mg [170, 480], p= 0.034). As compared to the CI group, the PIBI group consumed less tramadol during the first 24 hours (145 mg [87.5, 210] vs 190 mg [140, 400], p=0.012). The dermatomes anesthetized to the pinprick and cold test were significantly more abundant in the PIBI group than in the CI group (3 [3,4] vs. 5 [4,5], p<0.001). Both groups had similar VAS scores at rest and when moving (p>0.05). Additionally, the PIBI group showed greater patient satisfaction. Both groups experienced similar adverse events (p>0.05). Conclusion Compared with CI, PIBI administration regimen (0.3% ropivacaine 5 mL/h) for cSAPBs resulted in lower tramadol consumption, superior analgesia during the initial 12 h after the operation, and higher patient satisfaction. PIBI combined with cSAPBs was a better choice for postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery.
Collapse
Affiliation(s)
- Keqiang He
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Yan Meng
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Yun Zhu
- Department of Radiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, People’s Republic of China
| | - Sheng Wang
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| | - Yu Zong
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China
| |
Collapse
|
6
|
Lusianawati, Suhardi CJ, Sumartono C, Wungu CDK. Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis. Tzu Chi Med J 2023; 35:329-337. [PMID: 38035055 PMCID: PMC10683523 DOI: 10.4103/tcmj.tcmj_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The objective of this study was to compare the efficacy and safety of serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) in thoracic region surgery. Materials and Methods We implemented a systematic search of PubMed, ScienceDirect, SCOPUS, and Web of Science and through gray literature for all randomized controlled trials that compared SAPB, a novel thoracic wall nerve block, and TEA in surgery. The evaluated outcomes included the Visual Analog Scale (VAS), hypotension, and postoperative nausea and vomiting (PONV). Review Manager, version 5.4.1, was implemented for the analysis of statistics. Results The pooled analysis included six trials that fulfilled the inclusion criteria. In total 384, surgery had received regional blocks (162 - SAPB and 163 - TEA). VAS did not differ significantly between SAPB and TEA, with a mean difference of 0.71, P = 0.08. PONV incidence did not differ significantly between SAPB and TEA (odds ratio = 0.25, P = 0.07). Hypotension incidence was lower in SAPB compared to TEA (odds ratio = 0.10, P = 0.0001). Conclusion SAPB yielded comparable VAS with TEA in pain management of thoracic region surgery. The incidence of hypotension was lower in SAPB than in TEA. No difference in PONV incidence was observed. SAPB can be a viable alternative to TEA in thoracic region surgery.
Collapse
Affiliation(s)
- Lusianawati
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Christian Julio Suhardi
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Christrijogo Sumartono
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University/Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Spaans LN, Bousema JE, Meijer P, Bouwman RA(A, van den Broek R, Mourisse J, Dijkgraaf MGW, Verhagen AFTM, van den Broek FJC. Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6978197. [PMID: 36802255 PMCID: PMC9931052 DOI: 10.1093/icvts/ivad003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Pain after thoracoscopic surgery may increase the incidence of postoperative complications and impair recovery. Guidelines lack consensus regarding postoperative analgesia. We performed a systematic review and meta-analysis to determine the mean pain scores of different analgesic techniques (thoracic epidural analgesia, continuous or single-shot unilateral regional analgesia and only systemic analgesia) after thoracoscopic anatomical lung resection. METHODS Medline, Embase and Cochrane databases were searched until 1 October 2022. Patients undergoing at least >70% anatomical resections through thoracoscopy reporting postoperative pain scores were included. Due to a high inter-study variability an explorative meta-analysis next to an analytic meta-analysis was performed. The quality of evidence has been evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS A total of 51 studies comprising 5573 patients were included. Mean 24, 48 and 72 h pain scores with 95% confidence interval on a 0-10 scale were calculated. Length of hospital stay, postoperative nausea and vomiting, additional opioids and the use of rescue analgesia were analysed as secondary outcomes. A common-effect size was estimated with an extreme high heterogeneity for which pooling of the studies was not appropriate. An exploratory meta-analysis demonstrated acceptable mean pain scores of Numeric Rating Scale <4 for all analgesic techniques. CONCLUSIONS This extensive literature review and attempt to pool mean pain scores for meta-analysis demonstrates that unilateral regional analgesia is gaining popularity over thoracic epidural analgesia in thoracoscopic anatomical lung resection, despite great heterogeneity and limitations of current studies precluding such recommendations. PROSPERO REGISTRATION ID number 205311.
Collapse
Affiliation(s)
- Louisa N Spaans
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Jelle E Bousema
- Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands
| | - Patrick Meijer
- Department of Anesthesiology, Máxima Medical Center, Veldhoven, Netherlands
| | - R A (Arthur) Bouwman
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Renee van den Broek
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Jo Mourisse
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank J C van den Broek
- Corresponding author. Department of Surgery, Máxima MC, PO Box 7777, 5500 MB Veldhoven, Netherlands. Tel: +31-040-8888550; e-mail: (F.J.C. van den Broek)
| |
Collapse
|
9
|
Scorsese G, Jin Z, Greenspan S, Seiter C, Jiang Y, Huang MB, Lin J. Effectiveness of Thoracic Wall Blocks in Video-Assisted Thoracoscopic Surgery, a Network Meta-Analysis. J Pain Res 2023; 16:707-724. [PMID: 36915281 PMCID: PMC10007985 DOI: 10.2147/jpr.s396530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Thoracic epidural analgesia (TEA) and thoracic paravertebral blocks (PVB) are well-established techniques for pain management in thoracotomy. Here, we examine the efficacy of various thoracic fascial plane blocks vs TEA and PVB for intraoperative and postoperative analgesia for video assisted thoracoscopy surgery (VATS) with network meta-analysis. Methods A search for prospective randomized control studies using adult patients undergoing VATS with general anesthesia. The interventions of interest were any regional anesthesia techniques used for postoperative pain control after VATS. Primary outcomes of interest were 24-hour opioid requirement and 24-hour pain scores. A Bayesian network meta-analysis was conducted. Results We identified 42 studies that fulfilled our inclusion criteria. For patients who underwent VATS, TEA (MD = -27MME, 95% CI = -46.2 to -9MME), ESP (MD = -20MME, 95% CI -33 to -7.9MME), PVB (MD = -15MME, 95% CI = -26 to -4.5MME) demonstrated significant opioid sparing efficacy, as well as reduction in cumulative 24-hour static pain scores. However, exclusion of one study due to high risk of bias revealed that TEA did not significantly reduce opioid consumption, nor did it reduce the incidence of PONV, pulmonary complications, or LOS when compared to ESP, SAP, PVB, ICN, or PECS blocks. Conclusion Our findings suggest that TEA did not provide superior pain relief compared to ESP, SAP, PVB, ICN, or PECS blocks following VATS. Therefore, we propose ESP as a suitable intervention for the prevention of postoperative pain after VATS.
Collapse
Affiliation(s)
- Giacomo Scorsese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Seth Greenspan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Christopher Seiter
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Yujie Jiang
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, 98195-6540, USA
| | - Michael B Huang
- Health Sciences Library, Stony Brook University, Stony Brook, NY, 11794-8034, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| |
Collapse
|
10
|
Boisen ML, Fernando RJ, Alfaras-Melainis K, Hoffmann PJ, Kolarczyk LM, Teeter E, Schisler T, Ritchie PJ, La Colla L, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2021. J Cardiothorac Vasc Anesth 2022; 36:4252-4265. [PMID: 36220681 DOI: 10.1053/j.jvca.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Paul J Hoffmann
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter J Ritchie
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|
11
|
Jayadeep I, Srinivasan G, Sethuramachandran A, Elakkumanan LB, Swaminathan S, Bidkar P. Comparison of the Analgesic Efficacy of Ultrasound-Guided Superficial Serratus Anterior Plane Block With Deep Serratus Anterior Plane Block in Patients Undergoing Modified Radical Mastectomy: A Randomized Clinical Trial. Cureus 2022; 14:e30828. [DOI: 10.7759/cureus.30828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
|
12
|
Tan KW, Sayed Masri SNN, Musthafa QA, Mohd Azidin A, Nik Mohamed Kamil A, Izaham A, Md Nor N. Analgesic efficacy of the superficial versus deep serratus plane blocks for mastectomy with axillary clearance: A randomized controlled trial. Medicine (Baltimore) 2022; 101:e30515. [PMID: 36107598 PMCID: PMC9439770 DOI: 10.1097/md.0000000000030515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The serratus plane block is an effective technique for providing analgesia to patients undergoing breast surgery. METHODS This prospective, double-blind, randomized study enrolled 60 female patients scheduled for unilateral mastectomy and axillary clearance. The patients received either a superficial serratus plane block or deep serratus plane block. Dermatomal spread was recorded 30 minutes after block administration. Postoperatively, pain visual analog scale (VAS) scores were documented at recovery (time 0), at 30 minutes; and in the ward hourly for 4 hours, and 4-hourly until 24 hours postoperatively. The time to first analgesic rescue and cumulative morphine consumption using patient-controlled analgesia morphine (PCAM) were recorded. RESULTS The results showed lower VAS scores at rest (at 1, 2, 3, and 4 hours postoperatively), and during movement (at 1, 2, 3, 4, 8, and 24 hours postoperatively) in the superficial serratus plane block group, P < .005. Similarly, cumulative morphine usage was lower in the superficial serratus plane group, P < .005. The time to the first rescue analgesic was also significantly longer in the superficial group, P < .001. More patients in the superficial serratus plane group achieved greater dermatomal spread at T2 and T7 than those in the deep group. CONCLUSIONS Superficial serratus plane block provides better analgesic efficacy than deep serratus plane block in mastectomy and axillary clearance.
Collapse
Affiliation(s)
- Kok Wang Tan
- Department of Anaesthesiology & Intensive Care, Hospital Tuanku Jaafar Seremban, Negeri Sembilan, Malaysia
| | - Syarifah Noor Nazihah Sayed Masri
- Department of Anaesthesiology & Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- *Correspondence: Syarifah Noor Nazihah Sayed Masri, Department of Anaesthesiology & Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur, Malaysia (e-mail: )
| | - Qurratu Aini Musthafa
- Department of Anaesthesiology & Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azrin Mohd Azidin
- Department of Anaesthesiology & Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Azarinah Izaham
- Department of Anaesthesiology & Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nadia Md Nor
- Department of Anaesthesiology & Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth 2022; 36:2991-2999. [DOI: 10.1053/j.jvca.2022.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 11/11/2022]
|
14
|
Superficial vs. deep serratus anterior plane block for analgesia in patients undergoing mastectomy: A randomized prospective trial. J Clin Anesth 2021; 75:110470. [PMID: 34364099 DOI: 10.1016/j.jclinane.2021.110470] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE In the initial description of the serratus anterior plane block (SAPB), both superficial and deep SAPB provided effective blockade. The purpose of this study was to investigate the difference in opioid consumption and postoperative analgesia between superficial and deep SAPB for patients undergoing mastectomy. DESIGN Randomized prospective trial. SETTING Academic hospital. PATIENTS 64 women, >18 years of age, ASA I-III, undergoing single or bilateral mastectomy, with and without lymph node biopsy, with and without tissue expander reconstruction. INTERVENTION Either superficial or deep SAPB by an ultrasound-guided technique in addition to multimodal analgesia. MEASUREMENTS The primary outcome was opioid consumption in the first 24 h. Secondary outcomes were pain scores, satisfaction scores, incidence of PONV, length of stay and block performance time. RESULTS Subjects who received a deep SAPB required 30% less oral morphine equivalents (OME) (113.5 mg vs. 147 mg, p = 0.009) and reported lower pain scores. There were no significant differences in satisfaction scores, incidence of PONV, LOS, or block performance time between the two groups. CONCLUSION There was a significant difference in opioid consumption between the deep and superficial SAPB groups. Subjects in the deep SAPB group had lower pain scores at 12 h; however, the difference was not statistically significant at other time points. While both the superficial and the deep SAPB can be used for post-operative analgesia in patients undergoing mastectomy, our study suggests that the deep SAPB may improve analgesia to a greater degree than the superficial SAPB as shown through decreased opioid consumption of 30% over a 24-h period post-block. CLINICAL TRIAL NUMBER AND REGISTRY URL: clinicaltrials.gov: NCT03154658.
Collapse
|