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Cao X, Bao M, Ma Y, Ren J, Ma W, Bao Y, Ma C, Sui X, Nie Y. Hydromorphone combined with ropivacaine for erector spinae plane block in patients undergoing modified radical mastectomy: A prospective randomized controlled trial. Medicine (Baltimore) 2024; 103:e38758. [PMID: 38941366 DOI: 10.1097/md.0000000000038758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Combining hydromorphone with ropivacaine in ultrasound-guided erector spinae plane blocks enhances postoperative analgesia and reduces interleukin-6 expression in breast surgery patients. METHODS In this study, breast cancer patients undergoing modified radical mastectomy were randomized into 3 groups for anesthesia (30 patients in each group): standard general (group C), Erector Spinae Plane Block (ESPB) with ropivacaine (group R), and ESPB with ropivacaine plus hydromorphone (group HR). Diagnosis: Breast cancer patients. Postsurgery, pain levels, IL-6, anesthetic doses, additional analgesia needs, and recovery milestones were compared to evaluate the efficacy of the ESPB enhancements. RESULTS The 3 groups were not significantly different in baseline characteristics, operation time, number of cases with postoperative nausea, and serum IL-6 concentrations at T1 (the time of being returned to the ward after surgery). At T2 (at 6:00 in the next morning after surgery), the serum IL-6 concentration in group HR was significantly lower than that in groups R and C (P < .05); the intraoperative doses of remifentanil, sufentanil, and propofol were significantly lower in groups HR and R than those in group C (P < .05); Groups HR and R had significantly lower visual analog scale scores at T3 (4 hours postoperatively), T4 (12 hours postoperatively), and T5 (24 hours postoperatively) than those in group C (P < .05); the proportions of patients receiving postoperative remedial analgesia were significantly lower in groups HR and R than in group C (P < .05); groups HR and R had significantly lower proportions of patients with postoperative nausea than group C (P < .05); the time to the first anal exhaust and the time to the first ambulation after surgery were significantly shorter in groups HR and R than those in group C (P < .05). CONCLUSION Hydromorphone combined with ropivacaine for ESPB achieved a greater postoperative analgesic effect for patients receiving MRM under general anesthesia. The combined analgesia caused fewer adverse reactions and inhibited the expression level of the inflammatory factor IL-6 more effectively, thereby facilitating postoperative recovery. ESPB using hydromorphone with ropivacaine improved pain control post-MRM, reduced adverse effects, and more effectively suppressed IL-6, enhancing recovery.
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Affiliation(s)
- Xue Cao
- Graduate School of Inner Mongolia Medical University, Hohhot, China
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Malian Bao
- Department of Anesthesiology, Inner Mongolia Forth Hospital, Hohhot, China
| | - Yuhua Ma
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Jie Ren
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Weiwei Ma
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Yongli Bao
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Changfei Ma
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Xin Sui
- Department of Anesthesiology, Xing'anmeng People's Hospital, Ulanhot, China
| | - Yongzhen Nie
- Department of Anesthesiology, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
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Ran W, Luo H, Wang Z, Hao Y, Liang N, Li P, Yin X, Gao J. Can Ultrasound-Guided Continuous Paravertebral Block Reduce the Incidence of Chronic Postsurgical Pain in Patients with Thoracoscopic Lung Cancer Surgery? A Randomized Controlled Trial. Pain Res Manag 2023; 2023:6433494. [PMID: 38023825 PMCID: PMC10653976 DOI: 10.1155/2023/6433494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 07/17/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023]
Abstract
Background Thoracoscopic lung cancer surgery is accompanied by severe pain. Both continuous paravertebral block (CPVB) and continuous wound infiltration (CWI) are widely used for perioperative analgesia in thoracoscopic surgery. However, the effects of these different methods on chronic postsurgical pain (CPSP) are still unknown. Patients and Methods. This prospective randomized controlled trial assessed the eligibility of 113 patients. Ninety-seven patients who met the inclusion criteria were randomly divided into a CPVB group and a CWI group, and 80 patients were analyzed in the final study. The primary outcome measures were the incidence and intensity of chronic postsurgical pain (CPSP) at 3, 6, and 9 months after surgery. The secondary outcome measures were the numerical rating scale (NRS) score of rest and activity at 12, 18, and 24 hours and on the 2nd, 3rd, and 7th days postoperatively; the Barthel Activities of Daily Living (ADL) score of activity levels on the 1st, 2nd, 3rd, and 7th days postoperatively; and the long-term quality of the life score at 3, 6, and 9 months postoperatively. Results The incidence of chronic postsurgical pain in the CWI group was significantly higher than that in the CPVB group at 3, 6, and 9 months after surgery (all P < 0.05). The intensity of chronic postsurgical pain was significantly decreased in the CPVB group at 3, 6, and 9 months after surgery (P < 0.05). NRS-R and NRS-A scores were significantly decreased in the CPVB group within the first week after thoracoscopic surgery (P < 0.001). ADL scores were increased in the CPVB group within 3 days postoperatively. However, there were no differences in the ADL score on the 7th postoperative day or the long-term quality of the life score at 3, 6, and 9 months postoperatively. Conclusion Continuous ultrasound-guided paravertebral block reduced the intensity of acute pain within 7 days postoperatively and reduced the incidence of chronic pain at 3, 6, and 9 months after surgery, but there was no significant advantage in long-term quality of life. This trial is registered with ChiCTR2000038505.
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Affiliation(s)
- Wei Ran
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Huan Luo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zhiqiao Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yonggang Hao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ning Liang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ping Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xia Yin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jin Gao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Li J, Sun Q, Zong L, Li D, Jin X, Zhang L. Relative efficacy and safety of several regional analgesic techniques following thoracic surgery: a network meta-analysis of randomized controlled trials. Int J Surg 2023; 109:2404-2413. [PMID: 37402286 PMCID: PMC10442098 DOI: 10.1097/js9.0000000000000167] [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: 10/21/2021] [Accepted: 12/27/2022] [Indexed: 07/06/2023]
Abstract
BACKGROUND This network meta-analysis was performed to assess the relative efficacy and safety of various regional analgesic techniques used in thoracic surgery. MATERIALSAND METHODS Randomized controlled trials evaluating different regional analgesic methods were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to March 2021. The surface under the cumulative ranking curve) was estimated to rank the therapies based on the Bayesian theorem. Moreover, sensitivity and subgroup analyses were performed on the primary outcomes to obtain more reliable conclusions. RESULTS Fifty-four trials (3360 patients) containing six different methods were included. Thoracic paravertebral block and erector spinae plane block (ESPB) were ranked the highest in reducing postoperative pain. As for total adverse reactions and postoperative nausea and vomiting, postoperative complications, and duration of hospitalization, ESPB was found to be superior to other methods. It should be noted that there were few differences between various methods for all outcomes. CONCLUSIONS Available evidence suggests that ESPB might be the most effective and safest method for relieving pain after thoracic surgery, shortening the length of hospital stay and reducing the incidence of postoperative complications.
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Affiliation(s)
| | | | | | | | | | - Liwei Zhang
- Department of Thoracic Surgery, Xinjiang Medical University, First Affiliated Hospital, Urumqi, China
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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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Mo X, Jiang T, Wang H, Zhang Y. Erector Spinae Plane Block Combined with Serratus Anterior Plane Block Versus Thoracic Paravertebral Block for Postoperative Analgesia and Recovery After Thoracoscopic Surgery: A Randomized Controlled Non-inferiority Clinical Trial. Curr Med Sci 2023:10.1007/s11596-023-2745-2. [PMID: 37233969 DOI: 10.1007/s11596-023-2745-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/13/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aimed to compare the postoperative analgesia and recovery of ultrasound-guided erector spinae plane block combined with serratus anterior plane block (ESPB combined with SAPB) versus thoracic paravertebral block (PVB) after thoracoscopic surgery. METHODS Ninety-two patients who underwent video-assisted thoracoscopic surgery (VATS) were randomly divided into group S (n=46) and group P (n=46). After anesthesia induction, the same anesthesiologist performed ultrasound-guided ESPB at T5 and T7 levels combined with SAPB at the level of the fifth rib in the midaxillary line in group S and ultrasound-guided PVB at T5 and T7 levels in group P. Patients in both groups were given 40 mL of 0.4% ropivacaine. Eighty-six patients completed the study (group S, n=44; group P, n=42). The morphine consumption, visual analogue scale (VAS) scores at rest and coughing, and frequency of remedial analgesia were recorded at 1, 2, 4, 8, and 24 h postoperatively. Pulmonary function parameters were recorded at 1, 4, and 24 h postoperatively, and the quality of recovery (QoR)-15 score at 24 h postoperatively. The adverse effects, duration of chest tube drainage and length of stay were also recorded. RESULTS The morphine consumption at postoperative 4 and 8 h and the incidence of ipsilateral shoulder pain (ISP) were significantly lower in group S than in group P. The QoR-15 questionnaire score at postoperative 24 h was significantly lower in group P than in group S (P<0.05). The morphine consumption was lower at 24 h postoperatively in group S than in group P, with no significant difference found yet. The morphine consumption at other observed times, VAS scores, pulmonary function parameters, frequency of remedial analgesia, duration of chest tube drainage, length of stay, and incidence of other adverse events were comparable between group S and group P. CONCLUSION Ultrasound-guided ESPB combined with SAPB is non-inferior to PVB in terms of morphine consumption at postoperative 24 h and postoperative recovery. But, this approach can significantly reduce morphine consumption in the early postoperative period (0-8 h) after thoracoscopy with lower incidence of ISP. It is a simpler and safer operation.
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Affiliation(s)
- Xuan Mo
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tao Jiang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Han Wang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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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.
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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
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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.
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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
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Sandeep B, Huang X, Li Y, Xiong D, Zhu B, Xiao Z. A comparison of regional anesthesia techniques in patients undergoing video-assisted thoracic surgery: A network meta-analysis. Int J Surg 2022; 105:106840. [PMID: 36030040 DOI: 10.1016/j.ijsu.2022.106840] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain control remains challenging in patients undergoing video-assisted thoracoscopic surgery (VATS). This study aimed to investigate the relative efficacy of different regional anesthesia interventions for VATS using a Network Meta analysis (NMA). METHODS A literature search was conducted for NMA using Pubmed, The Cochrane Library, Embase, and the Web of Science databases to identify all randomized controlled trials (RCTs) that compared the analgesic effects of different regional analgesia techniques from inception to February 2022. The primary outcome was opioid consumption during the first 24 h postoperatively. The secondary outcomes were morphine consumption at 48 h postoperatively, pain intensity, postoperative nausea and vomiting, and hospital length of stay. Pain scores at two different intervals from different regional analgesia techniques were measured and investigated in this NMA. RESULTS A total of 38 RCTs (2224 patients) were included. Two studies compared three arm interventions of intercostal nerve block (ICNB) vs. thoracic paravertebral block (TPVB) vs. erector spinae plane block (ESPB) in intravenous morphine consumption at 24 h and 48 h postoperatively, and showed patients who received TPVB had less demand for morphine than ICNB and ESPB (P = 0.001, P = 0.001). For resting pain scores at 24 h postoperatively, ESPB was superior to serratus anterior plane block (SAPB) (P = 0.01), and TPVB provided effective analgesia compared to ICNB, retrolaminar block (RLB), and ESPB (P = 0.05, P = 0.01, P = 0.03). Similarly, pain scores at rest at 48 h, SAPB and TPVB showed the best results (P = 0.04, P = 0.001, P = 0.01) compared with local infiltration analgesia (LIA), ICNB, RLB, and ESPB. Additionally, pain scores at coughing at 24 h and 48 h, TPVB showed superior results compared with RLB,ESPB(P = 0.02, P = 0.02, P = 0.03). SAPB was superior to LIA in reducing the incidence of postoperative nausea and vomiting (P = 0.04). CONCLUSION In regional anaesthesia, TPVB is a better option than other analgesic methods, and its combination with other methods can be beneficial. However, our findings can only provide objective evidence. Clinicians should choose the treatment course based on the individual patient's condition and clinical situation.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China.
| | - Yuan Li
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Dan Xiong
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Bo Zhu
- Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
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Chen C, Xiang G, Chen K, Liu Q, Deng X, Zhang H, Yang D, Yan F. Ultrasound-guided Bilateral Serratus Anterior Plane Block for Postoperative Analgesia in Ear Reconstruction after Costal Cartilage Harvest: A Randomized Controlled Trial. Aesthetic Plast Surg 2022; 46:2006-2014. [PMID: 35918438 DOI: 10.1007/s00266-022-03027-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/12/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Costal cartilages harvest for ear reconstruction is accompanied by severe pain in chest. However, there is no perfect solution for reducing this chest pain. OBJECTIVE Evaluate the efficacy and safety of analgesia using ultrasound-guided bilateral serratus anterior plane block (SAPB) in children receiving costal cartilage harvest for ear reconstruction. METHODS Sixty children undergoing ear reconstruction using costal cartilage were randomized to an SAPB group (SAPB with 3 mg/kg 0.25% ropivacaine) or an incision infiltration (II) group (II with 3 mg/kg 0.75% ropivacaine), and 29 in each group completed the study. All children received patient-controlled intravenous analgesia (PCIA). The primary outcomes were numerical rating scale (NRS) scores of pain while rest and coughing at 1, 6, 12, 24, and 48 h after surgery. The secondary outcomes were sufentanil use within 24 h, duration of analgesia, use of oral rescue analgesics, first time out of bed, and incidence of treatment-related adverse effects. RESULTS The SAPB group had lower rest and coughing NRS scores at 6 and 12 h after surgery (all P < 0.001), but the scores were similar at other times. The SAPB group used less sufentanil within 24 h, but had a longer duration of analgesia (both P < 0.001). The II group used more oral rescue analgesics within 48 h, had a longer time until first time out of bed, and had more opioid-related side effects (all P < 0.01). There were no SAPB-related complications. CONCLUSION Ultrasound-guided SAPB can provide safe and effective regional pain relief after costal cartilage harvest for ear reconstruction. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .
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Affiliation(s)
- Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Hang Zhang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shi Jing Shan, No.33, Ba Da Chu Road, Beijing, 100144, China.
| | - Fuxia Yan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North Lishi Road, XiCheng District, Beijing, 100037, China.
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Effects of Nalbuphine Combined with Anterior Serratus Plane Block in Elderly Patients Undergoing Thoracoscopic Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7408951. [PMID: 35186237 PMCID: PMC8853809 DOI: 10.1155/2022/7408951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/03/2023]
Abstract
Postoperative pain in elderly patients with lung cancer after thoracoscopic surgery is still an important factor affecting the prognosis of patients. In this study, 200 elderly patients with lung cancer who were positive and planned to undergo video-assisted thoracoscopic surgery were randomly divided into four groups: control group, SAPB (serratus anterior plane block) group, Nalbuphine group and Nalbuphine + SAPB group. The effects of drugs and nerve block on the perioperative indexes of elderly patients were observed. The results showed that ① The VAS and SAS scores of postoperative analgesia in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ② The postoperative spontaneous respiratory recovery time, extubation time, resuscitation room stay time, extubation cough, restlessness and respiratory depression in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ③ The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) of patients in Nalbuphine + SAPB group before induction, T2 after intubation, T3 before skin incision, T4 after skin incision, T5 after chest closure and T6 after extubation were lower than those in single group and control group. Therefore, this study concluded that Nabufine combined with SAPB can make the vital signs of intraoperative patients more stable, which is worthy of clinical promotion.
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11
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The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery. Pain Ther 2021; 10:1051-1066. [PMID: 34537952 PMCID: PMC8586293 DOI: 10.1007/s40122-021-00322-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/08/2021] [Indexed: 10/27/2022] Open
Abstract
Although thoracoscopy has characteristics such as a small surgical incision and low stress response, post-surgical pain after a thoracoscopic operation is no less than that after a thoracotomy. Moreover, poor post-surgical pain management is likely to cause an increased incidence of postoperative pulmonary complications (PPCs) and chronic post-surgical pain. The serratus anterior plane block (SAPB) is a regional anesthesia method whereby local anesthetics (LAs) are injected into the serratus anterior space to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of video-assisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. Therefore, the SAPB can achieve effective analgesia in VATS. For example, 0.125% to 0.25% levobupivacaine (20-25 ml) is widely used for thoracic surgery, which can achieve effective analgesia and avoid adverse reactions. Moreover, it has advantages compared with thoracic segmental epidural block (TEA) and thoracic paravertebral block (TPVB), such as simple operation, increased safety, fewer complications, and hemodynamic stability. In addition, adequate analgesia is helpful for pulmonary function recovery and reduces the incidence of PPCs. This article introduces the anatomical mechanism of the SAPB, diverse operation approaches, how to choose drugs and adjuvants, and the resulting impacted area range. It summarizes the advantages and disadvantages of the SAPB compared with other analgesic methods and posits that the SAPB is beneficial to the recovery of postoperative lung function, which provides more options for postoperative analgesia after VATS.
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12
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Feray S, Lubach J, Joshi GP, Bonnet F, Van de Velde M. PROSPECT guidelines for video-assisted thoracoscopic surgery: a systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2021; 77:311-325. [PMID: 34739134 PMCID: PMC9297998 DOI: 10.1111/anae.15609] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 01/13/2023]
Abstract
Video‐assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video‐assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video‐assisted thoracoscopic surgery. A systematic review was undertaken using procedure‐specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non‐steroidal anti‐inflammatory drugs or cyclo‐oxygenase‐2‐specific inhibitors pre‐operatively or intra‐operatively and continued postoperatively. Intra‐operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first‐choice option. A serratus anterior plane block could also be administered as a second‐choice option. Opioids should be reserved as rescue analgesics in the postoperative period.
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Affiliation(s)
- S Feray
- Department of Anaesthesia, Intensive Care and Peri-operative Medicine, Hôpital Tenon, Paris, France
| | - J Lubach
- Department of Anaesthesiology, KU Leuven and University Hospital Leuven, Leuven, Belgium
| | - G P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F Bonnet
- Department of Anaesthesia, Intensive Care and Peri-operative Medicine, Hôpital Tenon, Paris, France
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven and University Hospital Leuven, Leuven, Belgium
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Pai P, Hong J, Phillips A, Lin HM, Lai YH. Serratus Anterior Plane Block Versus Intercostal Block with Incision Infiltration in Robotic-Assisted Thoracoscopic Surgery: A Randomized Controlled Pilot Trial. J Cardiothorac Vasc Anesth 2021; 36:2287-2294. [PMID: 34819261 DOI: 10.1053/j.jvca.2021.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Patients undergoing robotic video-assisted thoracoscopic surgery (rVATS) report significant postoperative pain. Both the serratus anterior plane block (SAPB) and the surgical intercostal block (IB) (performed by a surgeon from within the thorax), along with incision infiltration (II), are distinct modalities that target the lateral cutaneous branches of intercostal nerves and are acceptable analgesic modalities in an enhanced recovery after rVATS surgery. DESIGN Prospective, double-blinded, randomized, controlled pilot trial with 65 patients to assess the difference in analgesia quality between the SAPB and IB+II in rVATS. SETTING Major academic teaching hospital. PARTICIPANTS The inclusion criteria included ASA physical status I-IV, ages 18-to-75 undergoing an elective, unilateral rVATS procedure. INTERVENTIONS Patients were randomized to receive either an ultrasound-guided SAPB at the end of their surgery, using a 20-mL mixture consisting of 10 mL of liposomal bupivacaine (133 mg) and 10 mL 0.25% bupivacaine, or IB+II, using a 20-mL mixture consisting of 10 mL of liposomal bupivacaine (133 mg) and 10 mL 0.5% bupivacaine prior to skin closure by the surgeon. RESULTS The primary outcome was the amount of postoperative opioid consumption in morphine milliequivalents [MME] during the first 24 hours after surgery. Secondary outcomes were time to first analgesic request, VAS scores at zero, two, six, 18, or 24 hours at rest, and PACU, ICU, or hospital lengths of stay (LOS). There were no differences in any outcomes between the groups. CONCLUSIONS Both SAPB and IB+II are comparable analgesic modalities for rVATS procedures.
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Affiliation(s)
- Poonam Pai
- Mount Sinai West - Morningside Hospitals, Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
| | - Janet Hong
- Mount Sinai West - Morningside Hospitals, Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
| | - Annmarie Phillips
- Mount Sinai West - Morningside Hospitals, Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
| | - Hung-Mo Lin
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
| | - Yan H Lai
- Mount Sinai West - Morningside Hospitals, Department of Anesthesiology, Perioperative and Pain Medicine, New York, USA.
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The effect of ultrasound-guided serratus anterior plane block in addition to intrathecal morphine on early postoperative period after video-assisted thoracoscopic surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2021; 29:471-479. [PMID: 35096444 PMCID: PMC8762897 DOI: 10.5606/tgkdc.dergisi.2021.20804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/12/2021] [Indexed: 12/31/2022]
Abstract
Background
The aim of this study was to evaluate the effect of serratus anterior plane block in addition to intrathecal morphine for early postoperative period after video-assisted thoracoscopic surgery on the amount of morphine consumption and the Visual Analog Scale scores.
Methods
This single-blind, randomized-controlled study included a total of 64 patients (39 males, 25 females; mean age: 53.6±17.0 years; range, 20 to 89 years) who were scheduled for video-assisted thoracoscopic surgery in a tertiary hospital between September 2019 and March 2020. Postoperative pain control was achieved with intrathecal morphine 0.6 mg addition to serratus anterior plane block (Group ITM+SAPB) or with only intrathecal morphine (Group ITM) after an induction of anesthesia. The serratus anterior plane block was performed with a single injection of 0.4 mL/kg of 0.25% bupivacaine at the level of fifth rib with ultrasound guidance. Morphine consumption, pain scores, and side effects were recorded in the postoperative period.
Results
The mean morphine consumption was significantly lower in the ITM+SAPB group at all time points. Compared to the control group, the Visual Analog Scale-resting and coughing scores were significantly lower in the first 12 h after surgery. Pain scores were significantly higher in the ITM+SAPB group in patients where the trocar was inserted at upper level of the fifth rib than the lower level (3-5 vs. 5-8) during the first 6 h after surgery.
Conclusion
The use of serratus anterior plane block in addition to intrathecal morphine is a safe and effective way to improve pain control for early postoperative period after video-assisted thoracoscopic surgery. The serratus anterior plane block ensures better analgesia until the peak effect of spinal morphine occurs.
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15
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Gado AA, Abdalwahab A, Ali H, Alsadek WM, Ismail AA. Serratus Anterior Plane Block in Pediatric Patients Undergoing Thoracic Surgeries: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2021; 36:2271-2277. [PMID: 34607760 DOI: 10.1053/j.jvca.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE(S) This study was designed to evaluate the efficacy and safety of serratus anterior plane block (SAPB) as an analgesic technique for thoracotomies in pediatric patients. DESIGN Double-blinded randomized controlled trial. SETTING A single-center study at Aboelrish Pediatric Hospital, one tertiary hospital of Cairo University Hospitals. PARTICIPANTS Seventy pediatric patients aged six months-to-three years scheduled for thoracotomies. INTERVENTIONS Patients were randomized into two groups, group SF and group F. Group SF received an ultrasound-guided SAPB (n = 35), whereas group F (n = 35) did not. All groups received an intraoperative fentanyl infusion (at 0.5 μg/kg /h). MEASUREMENTS The primary outcome was the total dose of postoperatively administrated fentanyl in the first 24 hours. The secondary outcomes included the total dose of intraoperative additional fentanyl boluses; time of the first postoperative rescue analgesia; and postoperative Face, Legs, Activity, Cry, Consolability scale (FLACC) score values. MAIN RESULTS The main results of this study showed that the administrated fentanyl in the 24 hours postoperatively was significantly lower in SF group than in F group (p value ˂ 0.001). In addition, significant decreases of the postoperative FLACC pain score (p value ˂ 0.001), reduction of intraoperative fentanyl consumption (p value ˂ 0.001), and delay of the first rescue analgesia (p value ˂ 0.001) were recorded in SF group in relation to F group without significant complications in both groups. CONCLUSIONS Serratus anterior plane block can provide a safe, effective, and easy-to-perform regional technique for children undergoing thoracotomies.
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Affiliation(s)
- Ahmed Ali Gado
- Anesthesia and Pain Management, Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Abdalwahab
- Anesthesia and Pain Management, Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Hassan Ali
- Anesthesia and Pain Management, Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Wafaa Mohamed Alsadek
- Anesthesia and Pain Management, Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Abdelaziz Ismail
- Anesthesia and Pain Management, Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Egypt.
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Gupta AK, Mena S, Jin Z, Gan TJ, Bergese S. Postoperative pain: a review of emerging therapeutic options. Expert Rev Neurother 2021; 21:1085-1100. [PMID: 34461794 DOI: 10.1080/14737175.2021.1974840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Postoperative pain is often managed by opioid medications, even though they carry a risk of adverse effects such as vomiting, constipation, sedation, respiratory depression and physical dependence. Furthermore, opioid use in the healthcare setting has likely contributed to the epidemic. However, the mismanagement of postoperative pain can result in delayed recovery time, impaired physical function, increased risk of morbidity and mortality, chronic pain, and higher healthcare costs. AREAS COVERED This review explores emerging therapeutic options and strategies in the management of acute postoperative pain and focuses on opioid-sparing, multimodal analgesia. This includes regional anesthetic techniques, non opioid pharmacotherapy, novel opioids and non-pharmacologic therapy. We have also discussed examples of novel analgesics and formulations which have potential benefits in reducing postoperative pain and opioid use after surgery. EXPERT OPINION The development of novel regional anesthesia techniques allows for opioid minimization in increasing number of surgical procedures. This synergizes with the availability of novel non-opioid analgesic adjucts. In addition, several novel opioid drugs have been developed which may be pathway selective and associated with less adverse effect than conventional opioids.
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Affiliation(s)
- Abhishek K Gupta
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Shayla Mena
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, United States.,Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, United States
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17
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Kim DH, Kim SJ, Liu J, Beathe J, Memtsoudis SG. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med 2021; 46:600-617. [PMID: 34145072 DOI: 10.1136/rapm-2020-101909] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Abstract
Fascial plane blocks (FPBs) are increasingly numerous and are often touted as effective solutions to many perioperative challenges facing anesthesiologists. As 'new' FPBs are being described, questions regarding their effectiveness remain unanswered as appropriate studies are lacking and publications are often limited to case discussions or technical reports. It is often unclear if newly named FPBs truly represent a novel intervention with new indications, or if these new publications describe mere ultrasound facilitated modifications of existing techniques. Here, we present broad concepts and potential mechanisms of FPB. In addition, we discuss major FPBs of (1) the extremities (2) the posterior torso and (3) the anterior torso. The characteristics, indications and a brief summary of the literature on these blocks is included. Finally, we provide an estimate of the overall level of evidence currently supporting individual approaches as FPBs continue to rapidly evolve.
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Affiliation(s)
- David H Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Sang Jo Kim
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jiabin Liu
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan Beathe
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Stavros G Memtsoudis
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA .,Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
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18
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De Cassai A, Boscolo A, Zarantonello F, Piasentini E, Di Gregorio G, Munari M, Persona P, Zampirollo S, Zatta M, Navalesi P. Serratus anterior plane block for video-assisted thoracoscopic surgery: A meta-analysis of randomised controlled trials. Eur J Anaesthesiol 2021; 38:106-114. [PMID: 32833856 DOI: 10.1097/eja.0000000000001290] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The serratus anterior plane block (SAPb) is a promising interfascial plane technique able to provide profound thoracic analgesia. As only a few studies with quite small patient samples are presently available, the analgesic efficacy of adding SAPb to general anaesthesia in video-assisted thoracoscopic surgery (VATS), compared with general anaesthesia only, remains unclear. OBJECTIVES Our primary aim was to assess the analgesic efficacy of SAPb for VATS peri-operative pain control. The secondary aims were to evaluate differences in postoperative opioid use, intra-operative hypotension, postoperative side-effects and complications, time to chest tube removal, length of hospital stay. DESIGN Systematic review of randomised controlled trials (RCTs) with meta-analyses.DATA SOURCES PubMed, Web of Science, Google Scholar and the Cochrane Library, searched up to 6 December 2019.ELIGIBILITY CRITERIA RCTs including adult patients undergoing VATS who received single shot SAPb (cases), compared with general anaesthesia (controls). RESULTS Seven RCTs, with a total of 489 patients were included. SAPb reduced pain scores peri-operatively, compared with controls: 6 h [mean difference -1.86, 95% confidence interval (CI) -2.35 to -1.37, P < 0.001]; 12 h (mean difference -1.45, 95% CI -1.66 to -1.25, P < 0.001); 24 h (mean difference -0.98, 95% CI -1.40 to -0.56, P < 0.001). SAPb also reduced the use of postoperative opioids (mean difference: -4.81 mg of intravenous morphine equivalent, 95% CI -8.41 to -1.22, P < 0.03) and decreased the incidence of nausea and vomiting (risk ratio 0.53, 95% CI 0.36 to 0.79, P < 0.002). CONCLUSION Compared with general anaesthesia only and if no other locoregional techniques are used, SAPb significantly reduces postoperative pain and nausea and vomiting in patients undergoing VATS. Grading of Recommendations Assessment, Development and Evaluation rating are, nonetheless, quite low, due to high heterogeneity. Well designed and properly powered RCTs are necessary to confirm these preliminary findings.
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Affiliation(s)
- Alessandro De Cassai
- From the UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua (ADC, AB, FZ, EP, GDG, MM, PP) and UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy (SZ, MZ, PN)
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19
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Qiu L, Bu X, Shen J, Li M, Yang L, Xu Q, Chen Y, Yang J. Observation of the analgesic effect of superficial or deep anterior serratus plane block on patients undergoing thoracoscopic lobectomy. Medicine (Baltimore) 2021; 100:e24352. [PMID: 33546068 PMCID: PMC7837840 DOI: 10.1097/md.0000000000024352] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023] Open
Abstract
The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group): 1. general anesthesia group (P group); 2. combined general anesthesia and SSPB group (S group), and 3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.
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Affiliation(s)
- Lan Qiu
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, the First Affiliated Hospital of Soochow University, Suzhou
- Department of Anesthesiology
| | | | | | - Min Li
- Department of Anesthesiology
| | | | | | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jianping Yang
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, the First Affiliated Hospital of Soochow University, Suzhou
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20
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Datu M, Prasetyadhi J. Serratus anterior plane block in modified radical mastectomy surgery: A case series. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Shang LH, Xiao ZN, Zhao YL, Long B. Analgesic Effect of Serratus Anterior Plane Block After Thoracoscopic Surgery: A Randomized Controlled Double-Blinded Study. Ther Clin Risk Manag 2020; 16:1257-1265. [PMID: 33376335 PMCID: PMC7755330 DOI: 10.2147/tcrm.s285244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Fast-track surgery is a developing trend in medical care. It is a core challenge for clinical anesthesia to reasonably reduce the dosage of opioids and relieve postoperative pain. Serratus anterior plane block (SAPB) is a novel analgesic technique with such advantages as easy operation, good safety, and few side effects. Patients and Methods In total, 60 patients aged 18 to 65 years who were diagnosed with lung cancer and scheduled for thoracoscopic resection were randomly assigned to receive SABP or local infiltration anesthesia. We analyzed the time within 48 hrs after operation to visual analogue scale (VAS) pain score of 4 or higher and the number of patients requiring additional analgesics at 6 hrs and 12 hrs after operation. Results The estimated median time to VAS ≥4 was 4 hrs (1.32 to 6.68) in the control group and 11 hrs (6.71 to 15.29) in the SAPB group (log-rank test: P=0.008). The number of patients requiring additional analgesics at 6- and 12 hrs after operation was significantly lower in the SAPB group than that in the control group (P<0.05). Conclusion Compared with local infiltration, SAPB provided extended postoperative analgesia after thoracoscopic surgery with reduced consumption of additional analgesics in the early postoperative stage.
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Affiliation(s)
- Li Hua Shang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Zhen Nan Xiao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Ya Li Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Bo Long
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
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22
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Lee J, Lee DH, Kim S. Serratus anterior plane block versus intercostal nerve block for postoperative analgesic effect after video-assisted thoracoscopic lobectomy: A randomized prospective study. Medicine (Baltimore) 2020; 99:e22102. [PMID: 33285665 PMCID: PMC7717779 DOI: 10.1097/md.0000000000022102] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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 Serratus anterior plane block (SAPB) and intercostal nerve block (ICNB) are attractive options for multimodal analgesia in patients undergoing thoracoscopic surgery, but which block is superior remains unclear. OBJECTIVE The present study aimed to assess the effect of SAPB versus ICNB on reducing postoperative pain after video-assisted thoracoscopic surgery (VATS) for lobectomy. METHODS This prospective, randomized, active-intervention-controlled, subject-assessor-blinded, single-center, parallel-group trial allocated 18- to 80-year-old patients with American Society of Anesthesiologists status I to III to receive either SAPB or ICNB in a 1:1 ratio. The primary outcome was numerical pain rating scale (NRS) scores during the first 24 hours postoperatively. The secondary outcomes were postoperative cumulative doses of ketorolac and fentanyl, and the occurrence of postoperative adverse effects. RESULTS Among the 57 patients assessed for eligibility, 50 were randomly assigned in a 1:1 ratio. Due to conversion to open thoracotomy and patient-controlled analgesia pump failure, 4 patients were excluded and 46 were analyzed. The intergroup differences in NRS scores were not statistically significant at any time point. Cumulative consumptions of fentanyl and ketorolac were also not significantly different. No perioperative adverse events occurred. Postoperative complications were also absent, except for nausea (2/23 patients [8.7% in both groups]). CONCLUSION Results of the present study do not clarify whether SAPB or ICNB has a superior effect on reducing pain after VATS, thereby suggesting they may exert similar analgesic effects.
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Affiliation(s)
- Jungwon Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Deok Heon Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Mehdiratta L, Bajwa SJS, Malhotra N, Joshi M. Exploring cocktails, remixes and innovations in regional nerve blocks: The clinical research journey continues. Indian J Anaesth 2020; 64:1003-1006. [PMID: 33542561 PMCID: PMC7852434 DOI: 10.4103/ija.ija_1517_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lalit Mehdiratta
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Center, Bhopal, Madhya Pradesh, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Rajpura, Patiala, Punjab, India. E-mail:
| | - Naveen Malhotra
- Department of Anaesthesiology, In Charge Pain Management Centre, Pt BDS PGIMS, Rohtak, Haryana, India
| | - Muralidhar Joshi
- Department of Anaesthesiology and Pain Medicine, Virinchi Hospitals, Hyderabad, Telangana, India
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Moon S, Lee J, Kim H, Kim J, Kim J, Kim S. Comparison of the intraoperative analgesic efficacy between ultrasound-guided deep and superficial serratus anterior plane block during video-assisted thoracoscopic lobectomy: A prospective randomized clinical trial. Medicine (Baltimore) 2020; 99:e23214. [PMID: 33217833 PMCID: PMC7676537 DOI: 10.1097/md.0000000000023214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The serratus anterior plane block (SAPB) is a novel method that provides lateral chest wall analgesia. There are 2 methods of SAPB; deep and superficial SAPB. Each of these methods has been demonstrated to provide effective perioperative analgesia in thoracic surgery. The aim of this study was to compare the intraoperative hemodynamic and analgesic benefits of deep versus superficial SAPB during video-assisted thoracic surgery (VATS) lobectomy. METHODS We performed a prospective, randomized, patient/assessor-blinded trial. We included patients who were 20 to 75 years of age and scheduled to undergo VATS lobectomy with American Society of Anesthesiologists physical status 1 or 2. Patients were randomly allocated to receive either ultrasound-guided deep SAPB (Group D) or superficial SAPB (Group S). The primary outcome was intraoperative remifentanil consumption. We also recorded intraoperative systolic blood pressure (SBP), heart rate (HR), emergence time, and doses of rescue drugs used to manage hemodynamic instability. RESULTS Data for 50 patients undergoing 3-port VATS lobectomy were analyzed. Intraoperative remifentanil consumption did not differ significantly between Group D (n = 25, 715.62 ± 320.36 μg) and group S (n = 25, 721.08 ± 294.48 μg) (P = .97). Additionally, there were no significant differences between the 2 groups in SBP and HR at any time point, emergence time, or amount of rescue drugs used. CONCLUSION Our study suggests that the intraoperative analgesic efficacy is similar for deep and superficial SAPB during VATS lobectomy.
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Affiliation(s)
- Suyoung Moon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University
| | - Jungwon Lee
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Jeongeun Kim
- Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine
| | - Jiseob Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University
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25
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Datu MD, Prasetyadhi J. Serratus anterior plane block in modified radical mastectomy surgery: a case series. JA Clin Rep 2020; 6:82. [PMID: 33057828 PMCID: PMC7561635 DOI: 10.1186/s40981-020-00373-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Postoperative breast pain may lead to poorer outcome if left untreated. Common analgesia modalities for postoperative breast pain include opioids and regional anesthesia. However, both of these modalities can cause significant side effects or complications. Serratus anterior plane (SAP) block is a new procedure that is relatively easier to perform and safer, compared with other modalities. Previous studies have reported its usefulness in reducing the need for both intraoperative and postoperative opioids. Case We reported 2 patients that underwent SAP block combined with general anesthesia in modified radical mastectomy (MRM). Patient 2 was given rescue analgesia during the intraoperative period. The administration of postoperative opioids did not exceed 24 h in both patients. Pain assessment using numeric rating scale (NRS) showed minimal postoperative pain. No side effects were found during 24-h monitoring period. Conclusion SAP block can be used as one of the modalities in managing the pain of MRM surgery.
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Affiliation(s)
- Madonna Damayanthie Datu
- Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University/ RSUP Dr. Wahidin Sudirohusodo, Jl. Perintis Kemerdekaan KM. 11, Makassar, Tamalanrea, 90245, Indonesia.
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Li X, Liu Y, Zhao J, Xiang Z, Ren C, Qiao K. 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. J Pain Res 2020; 13:1785-1795. [PMID: 32801843 PMCID: PMC7381820 DOI: 10.2147/jpr.s258443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022] Open
Abstract
Background Although video-assisted thoracic surgery (VATS) can significantly reduce postoperative pain, the incidence is as high as 30–50%. The purpose of this study was to explore the safety and efficacy of ultrasound-guided serratus anterior plane block (SAPB) combined with dexmedetomidine (Dex) for patients undergoing VATS. Methods Eighty patients were randomized into two groups (20 mL 0.5% ropivacaine plus 0.5 µg/kg or 1 µg/kg Dex). Primary outcome was the visual analog scale of pain while coughing (VASc) score at 24 h after surgery. Secondary outcomes included hemodynamics, sufentanil consumption, number of patients needing rescue analgesia, time to first rescue analgesic, total dose of rescue analgesic, satisfaction scores of patients and surgeons, time of chest tube removal, length of hospital stay, adverse effects, the prevalence of chronic pain and quality of life. Results Compared with D1 group, visual analog scale of pain at rest (VASr) was significantly lower during the first 24 h after surgery, while VASc was significantly lower during the first 48 h after surgery (P<0.05). Mean arterial pressure was significantly decreased from T2 to T8, and heart rate was significantly decreased from T2 to T7 in the D2 group (P<0.05). Consumption of sevoflurane, remifentanil, DEX and the recovery time were significantly reduced in the D2 group (P <0.05). Consumption of sufentanil 8–72 h after surgery was significantly lower in the D2 group (P<0.05). Additionally, the number of patients who required rescue analgesia, the time to the first dose of rescue analgesia, and the total dose of rescue analgesia was significantly lower in the D2 group (P<0.05). Conclusion The results of this study show that 1 µg/kg DEX is a beneficial adjuvant to ropivacaine for single-injection SAPB in VATS patients while stable hemodynamics were maintained.
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Affiliation(s)
- Xiang Li
- Department of Anesthesiology, The First People's Hospital of Tianmen, Tianmen, Hubei, People's Republic of China
| | - Yanchao Liu
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China
| | - Jing Zhao
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China
| | - Zhixiong Xiang
- Department of Anesthesiology, The First People's Hospital of Tianmen, Tianmen, Hubei, People's Republic of China
| | - Chunguang Ren
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China
| | - Kekun Qiao
- Department of Anesthesiology, The First People's Hospital of Tianmen, Tianmen, Hubei, People's Republic of China
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27
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O J, Kwon HJ, Cho TH, Won SY, Yang HM. Analysis of the positional relationship of the long thoracic nerve considering clinical treatment. Clin Anat 2020; 34:617-623. [PMID: 32644204 DOI: 10.1002/ca.23647] [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: 03/15/2020] [Revised: 06/22/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The long thoracic nerve (LTN) has a risk of being damaged during chest surgery and should be considered when performing anesthesia such as a serratus anterior plane block (SAPB). We analyzed the relationship between landmarks-the fourth to ninth intercostal space (ICS) at the midaxillary line (MAL), through which the distal part of the LTN passes-and the LTN. MATERIALS AND METHODS We used 25 specimens from 17 embalmed Korean cadavers. The MAL, level of rib and ICS, and regions 5 cm anteroposterior to the MAL (aMAL/pMAL) were established to measure the position of the LTN crossing the MAL, pathway of the LTN, and entering points of the LTN to the SA. RESULTS The LTN crossed the MAL in 76% of the specimens. The LTN crossed the MAL within the fifth to sixth rib level in 70.8%. Seventy-six percent of the branches entered the SA within the fourth to sixth ICS. The fifth rib and ICS were the most frequent regions aMAL; however, several branches were found pMAL. The LTN entered the SA in 92.6% of the specimens within 3 cm anterior and 1 cm posterior to the MAL. CONCLUSIONS We set the danger zone as 4 cm near the MAL at the fourth to sixth ICS for thoracotomy. In addition, we proposed the fifth ICS in aMAL at the superficial plane as the alternative injection point for SAPB when blocking the LTN, and the fifth ICS in pMAL at the deep plane to prevent blocking the LTN.
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Affiliation(s)
- Jehoon O
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyeon Cho
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Yoon Won
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.,Surgical Anatomy Education Centre, Yonsei University College of Medicine, Seoul, Republic of Korea
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28
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Kim S, Bae CM, Do YW, Moon S, Baek SI, Lee DH. Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic Surgery. Thorac Cardiovasc Surg 2020; 69:564-569. [PMID: 32222960 DOI: 10.1055/s-0040-1705152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to compare the postoperative analgesic effect between ultrasound-guided serratus anterior plane block (Group S, SAPB) and intercostal nerve block (Group I, ICNB) after single port video-assisted thoracoscopic surgery (S-VATS) in primary spontaneous pneumothorax. METHODS In this prospective randomized controlled study, 54 patients were randomly assigned to two groups. Patients in Group S underwent the SAPB before the surgical drape by an anesthesiologist, and in Group I, ICNBs were performed just before the wound closure after S-VATS by an attending thoracic surgeon. The primary outcome was the numeric pain rating scale (NRS) score given by the patients for pain at the surgical incision site. NRS was assessed during resting and coughing statuses at 3, 6, and 12 hours postoperatively and at the time of the chest tube removal. The secondary outcomes included the number of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid administration until time to chest tube removal. RESULTS There were no statistical differences between the two groups regarding age, body mass index, duration of operation, duration of anesthesia, and average NRS scores for the assigned time periods. There was no statistical significance in the number of opioid injections; however, NSAIDs were administered 2.8 times per patient in Group I, and 1.9 times per patient in Group S (p = 0.038). CONCLUSION In the patients who underwent S-VATS with primary spontaneous pneumothorax, the SAPB provided similar postoperative pain relief with reducing the NSAIDs consumption compared with ICNB.
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Affiliation(s)
- Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chae-Min Bae
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Suyoung Moon
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ik Baek
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
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Yang J, Hao Z, Li W, Duan C, Fan X, Xin J, Ren C. The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial. J Pain Res 2020; 13:355-366. [PMID: 32104057 PMCID: PMC7025740 DOI: 10.2147/jpr.s244787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.
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Affiliation(s)
- Junling Yang
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Zaijun Hao
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Wei Li
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Caiping Duan
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Xiujuan Fan
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Jing Xin
- Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China
| | - Chunguang Ren
- Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China
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Viti A, Bertoglio P, Zamperini M, Tubaro A, Menestrina N, Bonadiman S, Avesani R, Guerriero M, Terzi A. Serratus plane block for video-assisted thoracoscopic surgery major lung resection: a randomized controlled trial. Interact Cardiovasc Thorac Surg 2019; 30:366-372. [DOI: 10.1093/icvts/ivz289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 01/17/2023] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate the impact of 2 different analgesic approaches on pain, postoperative rehabilitation exercises and rescue analgesics of 2 groups of patients undergoing video-assisted thoracoscopic surgery (VATS) major lung resection for cancer.
METHODS
A total of 94 patients undergoing a VATS major lung resection were randomly allocated to 2 groups: the control group received intravenous and oral (i.e. systemic) analgesics while the intervention group received systemic analgesics plus pre-emptive serratus plane block. Pain perception was recorded until drainage removal or until 2 p.m. of postoperative day (POD) 3. In particular, the primary end point was defined as the peak pain perception on POD 1 (in the time frame between 6 a.m. and 2 p.m.). Secondary end points were the number of forced inspiration manoeuvers during rehabilitative incentive spirometry on POD 1 and 2 and the overall number of rescue analgesics requested by patients.
RESULTS
Serratus plane block provided a better pain control between 6 a.m. and 2 p.m. of POD 1 (Numeric Rating Scale 1.7 vs 3.5; P < 0.001). Patients in the intervention group performed more forced inspiration manoeuvers at a mean higher volume during incentive spirometry (8.9 vs 7, P < 0.001, and 1010 vs 865 ml, P = 0.02). They required fewer rescue doses of analgesics (0.57 vs 1.1; P = 0.008).
CONCLUSIONS
Serratus plane block provided a better pain control, entailing a better performance during postoperative rehabilitation exercises in terms of duration and quality of incentive spirometry. It diminished the patient’s need for rescue analgesics during the early postoperative period.
Clinical trial registration number
NCT03134729.
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Affiliation(s)
- Andrea Viti
- Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Pietro Bertoglio
- Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Massimo Zamperini
- Department of Anesthesia, Intensive Care and Pain Therapy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Alessandro Tubaro
- Department of Anesthesia, Intensive Care and Pain Therapy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Nicola Menestrina
- Department of Anesthesia, Intensive Care and Pain Therapy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Silvia Bonadiman
- Respiratory Rehabilitation Service, Rehabilitation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Renato Avesani
- Respiratory Rehabilitation Service, Rehabilitation Department, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Massimo Guerriero
- Clinical Research Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
- Applied Statistics Department, University of Verona, Verona, Italy
| | - Alberto Terzi
- Thoracic Surgery, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
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Gao S, Barello S, Chen L, Chen C, Che G, Cai K, Crisci R, D'Andrilli A, Droghetti A, Fu X, Ferrari PA, Fernando HC, Ge D, Graffigna G, Huang Y, Hu J, Jiao W, Jiang G, Li X, Li H, Li S, Liu L, Ma H, Ma D, Martinez G, Maurizi G, Phan K, Qiao K, Refai M, Rendina EA, Shao G, Shen J, Tian H, Voltolini L, Vannucci J, Vanni C, Wu Q, Xu S, Yu F, Zhao S, Zhang P, Zhang L, Zhi X, Zhu C, Ng C, Sihoe ADL, Ho AMH. Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery. Transl Lung Cancer Res 2019; 8:1174-1187. [PMID: 32010595 DOI: 10.21037/tlcr.2019.12.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgery, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Serena Barello
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Liang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 211166, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350122, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Kaican Cai
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Roberto Crisci
- Division of Thoracic Surgery, University of L'Aquila, Mazzini Hospital, Teramo, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Yunchao Huang
- Department of Thoracic Surgery, Cancer Research Institute of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Wenjie Jiao
- Division of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266555, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100032, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Soochow 215006, China
| | - Dongchun Ma
- Department of Cardiothoracic Surgery, Anhui Chest Hospital, Hefei 230022, China
| | - Guillermo Martinez
- Department of Anesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Kevin Phan
- Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kun Qiao
- Department of Thoracic Surgery, The Third People's Hospital of Shenzhen, Shenzhen 518034, China
| | - Majed Refai
- Division of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Guoguang Shao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun 130021, China
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Hui Tian
- Department of Thoracic Surgery, The Qilu Hospital of Shandong University, Jinan 250012, China
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Shidong Xu
- Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Tianjing General Hospital of Tianjing Medical University, Tianjing 300052, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Calvin Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | | | - Anthony M H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University Kingston, Ontario, Canada
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