Analgesic efficacy and safety of erector spinae versus serratus anterior plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) are regional anesthesia techniques that have shown favorable results in pain management following thoracic surgeries; however, their relative superiority is unclear. This review (PROSPERO: CRD42023443018) aims to compare the analgesic efficacy of ESPB and SAPB in patients undergoing thoracic surgeries through the pooled analysis of co-primary outcomes: postoperative oral-morphine-equivalent (mg) consumption in 24 h and pain scores (static) at 24 h.

METHODS

A literature search was conducted across PubMed, Cochrane Library, and Google Scholar to identify randomized controlled trials (RCTs) from inception to May 2023, comparing ESPB and SAPB in thoracic surgeries. Statistical pooling was done using Review Manager 5.4.1. Bias assessment employed the Cochrane Collaboration Risk-of-Bias 2.0 tool. The strength of evidence was assessed using the guidelines from the GRADE working group.

RESULTS

Nine RCTs (485 patients) were included in the study. Postoperative pain scores (static) at 24 h (mean difference (MD) =  - 0.31 [- 0.57, 0.05], p = 0.02) and postoperative oral-morphine-equivalent (mg) consumption in 24 h (MD =  - 19.73 [- 25.65, - 13.80], p < 0.00001) were significantly lower in the ESBP group. However, the MDs did not exceed the set threshold for clinical importance. No significant differences were observed in the opioid-related adverse effects and block-related complications.

CONCLUSION

Our statistically significant results imply that ESPB has superior analgesic efficacy compared to SAPB; however, this difference is clinically unimportant. The safety profile of the two blocks is comparable; hence, current evidence cannot define the relative superiority of one block over the other. Our findings warrant further research with standardized methodologies and a longer duration of analgesic efficacy assessment to yield robust evidence for better clinical applications.

Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

Nasopharyngeal cyst of branchiogenic origin: report of a case and review of the literature

To date, only 22 cases of nasopharyngeal cyst of branchiogenic origin have been reported in the literature. In this article, we report a new case in a 35-year-old woman. We also present a review of the literature and a discussion of the sites of origin, histopathology, and treatment modalities.

Mediastinal emphysema associated with functional endoscopic sinus surgery. A case report

A case of mediastinal emphysema after functional endoscopic sinus surgery (FESS) is presented. Mediastinal emphysema is a rare and previously unreported complication after FESS. The possible aetiologies are discussed.

Granulomatous osteomyelitis of the maxillary sinus

A case of granulomatous osteomyelitis of the maxilla, probably due to tuberculosis is reported, and the literature reviewed. Excision of the diseased tissue with antitubercular treatment forms the most effective line of treatment.

Amino acid requirements of the breeding sow. 2. The dietary lysine requirement of the lactating sow

1. Two experiments, involving six lactating Landacre x (Landrace x Large White) sows were undertaken to study the lysine requirement of the lactating sow and to identify the second limiting amino acid by means of interpretation of plasma amino acid and blood urea levels. 2. A basal diet composed mainly of equal amounts of ground barley and ground wheat supplemented with mineral and vitamin mixtures was used. This diet was supplemented with synthetic amino acids (lysine threonine, tryptophan, methionine and isoleucine). 3. Plasma amino acid and blood urea values showed a close agreement and indicated that lysine intake above 38.4 g/d was in excess of the requirement level. 4. Plasma amino acid values suggested tryptophan to be the second limiting amino acid whereas blood urea values suggested threonine to be the second limiting amino acids.

Amino acid requirements of the breeding sow: the dietary lysine requirement during pregnancy

1. Four pregnant sows were used to study lysine requirements by means of the interpretation of values for plasma amino acid and blood urea. Diets containing graded levels of dietary lysine were fed at the rate of 1.82 kg/d. 2. Plasma lysine remained at a low level up to 6.4 g dietary lysine/kg (dry matter basis) and then increased sharply with further increases in lysine intake. 3. Blood urea levels decreased when the dietary lysine content was increased to 6.4 g/kg and then increased at higher dietary lysine concentrations. 4. Both criteria of response indicated that the lysine requirement of the pregnant sow given 1.82 kg diet/d during the later stages of pregnancy does not exceed 10.00 g/d.

Embryonal rhabdosarcoma of the middle ear and mastoid

Two cases of embryonal rhabdomyosarcoma, arising from the middle ear, are described. It is a rare mesenchymal tumour of childhood, with a very poor prognosis. The literature is briefly reviewed and the difficulties encountered in diagnosis are outlined.

The variation in the concentration of plasma amino acids and blood urea in pregnant sows

Two pregnant sows were fed on a basal diet consisting of equal amounts of ground barley and ground wheat with or without addition of L-lysine hydrochloride. Plasma amino acid and blood urea levels varied according to the time after feeding. Almost all the essential amino acids reached a maximum level after one hour and then declined at four hours after feeding. The results suggested that samples taken at between one and four hours after feeding were responsive to changes in dietary composition and could provide a measure to evaluate the amino acid pattern in relation to feeding. Both plasma amino acid and blood urea data suggested that lysine was the first limiting amino acid in the basal diet.

Hamartomas of the nose

Three cases of hamartomas of the nose, very rare conditions in otolaryngology are reported. According to the Willis (1953) classification two of these cases, belonged to the angiomatous, and the third one to the lipomatous, group of hamartomas.