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The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study

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Abstract

Purpose

A multimodal analgesic approach is necessary for post-thoracotomy pain, which can be severe. Intravenous access, central and peripheral nerve blocks are frequently used. The aim of this study was to evaluate the efficacy of serratus anterior plane block (SAPB) in the management of post-thoracotomy pain.

Methods

A total of 40 patients who underwent thoracotomy between January 2014 and January 2016 were retrospectively analyzed. The patients were divided into two groups: Group M (intravenous patient-controlled analgesia morphine; n = 20) and Group S (intravenous patient-controlled analgesia morphine + SAPB; n = 20). The Visual Analogue Scale (VAS) was used for pain evaluation at the 1st, 2nd, 4th, 6th, 8th, 12th and 24th postoperative hours and morphine consumption was evaluated at the 6th, 12th and 24th postoperative hours. Secondary outcomes were additional analgesic requirement, side effects, the Ramsay Sedation Scale (RSS) scores, block onset time and block level.

Results

The VAS scores and the amount of morphine consumed at the 6th, 12th and 24th hours were found to be significantly lower in Group S than in Group M (P < 0.001). No statistically significant difference was found in the rate of side effects, including nausea, vomiting, pruritus, respiratory depression, bradycardia and hypotension, and RSS outcomes between the groups.

Conclusion

Our study suggests that SAPB is an effective adjuvant treatment option for thoracotomy analgesia.

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References

  1. Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology. 1994;81:737–59.

    Article  CAS  PubMed  Google Scholar 

  2. Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. Review articles. Cardiothorac Vasc Anesth. 2014;28:1060–8.

    Article  Google Scholar 

  3. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In: Miller RD, editor. Miller’s anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 1942–2006.

    Google Scholar 

  4. Fiorelli A, Mazzella A, Passavanti B, Sansone P, Chiodini P, Iannotti M, Aurilio C, Santinİ M. Is pre-emptive administration of ketamine a significant adjunction to intravenous morphine analgesia for controlling postoperative pain? A randomized, double-blind, placebo-controlled clinical trial. Interact Cardiovasc Thorac Surg. 2015;21:284–91.

    Article  PubMed  Google Scholar 

  5. Michelet P, Guervilly C, Hélaine A, Avaro JP, Blayac D, Gaillat F, Dantin T, Thomas P, Kerbaul F. Adding ketamine to morphine for patient controlled analgesia after thoracic surgery: influence on morphine consumption, respiratory function, and nocturnal desaturation. Br J Anaesth. 2007;99(3):396–403.

    Article  CAS  PubMed  Google Scholar 

  6. Turktan M, Unlugenc H, Gulec E, Gezer S, Isik G. Coadministration of intravenous remifentanil and morphine for post-thoracotomy pain: comparison with intravenous morphine alone. J Cardiothorac Vasc Anesth. 2015;29(1):133–8.

    Article  CAS  PubMed  Google Scholar 

  7. Demirhan A, Gül R, Ganidağlı S, Koruk S, Mızrak A, Şanlı M, Oner U. Combination of dexmedetomidine and tramadol in the treatment of pain after thoracotomy. GKDA Derg. 2011;17:34–41.

    Article  Google Scholar 

  8. Freynet A, Falcoz PE. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg. 2010;10:283–8.

    Article  PubMed  Google Scholar 

  9. Debreceni G, Molnar Z, Szelig L, Molnar TF. Continuous epidural or intercostal analgesia following thoracotomy: a prospective randomized double-blind clinical trial. Acta Anaesthesiol Scand. 2003;47:1091–5.

    Article  CAS  PubMed  Google Scholar 

  10. Schnieder RF, Villamena PC, Harvey J, Surick BG, Surick IW, Beattie EJ. Lack of efficacy of intrapleural bupivacaine for postoperative analgesia following thoracotomy. Chest. 1993;103:414–6.

    Article  Google Scholar 

  11. Mohammad W, Mir SA, Mohammad K, Sofi K. A randomized double blind study to evaluate efficacy and safety of epidural magnesium sulfate and clonidine as adjuvants to bupivacaine for postthoracotomy pain relief. Anesth Essays Res. 2015;9(1):15–20.

    PubMed  PubMed Central  Google Scholar 

  12. Blanco R. The ‘Pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8.

    Article  CAS  PubMed  Google Scholar 

  13. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultra-sound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616–7.

    CAS  PubMed  Google Scholar 

  14. Blanco R, Parras T, McDonnell JG, Prats- Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.

    Article  CAS  PubMed  Google Scholar 

  15. Takimoto K, Nishijima K, Ono M. Serratus plane block for persistent pain after partial mastectomy and axillary node dissection. Pain Physician. 2016;19(3):E481–6.

    PubMed  Google Scholar 

  16. Zhou Y, Huang JX, Lu XH, Zhang YF, Zhang W. Patient-controlled intravenous analgesia for non-small cell lung cancer patient after thoracotomy. J Cancer Res Ther. 2015;11(Suppl 1):C128–30.

    CAS  PubMed  Google Scholar 

  17. Lönqvist PA, McKenzie J, Soni AK, Conacher AD. Paravertebral blockade: failure rate and complications. Anesthesia. 1995;50:813–5.

    Article  Google Scholar 

  18. Gulbahar G, Kocer B, Muratli SN, Yildirim E, Gulbahar O, Dural K, Sakinci U. A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg. 2010;37(2):467–72.

    PubMed  Google Scholar 

  19. Bhoi D, Pushparajan HK, Talawar P, Kumar A, Baidya DK. Serratus anterior plane block for breast surgery in a morbidly obese patient. J Clin Anesth. 2016;33:500–1.

    Article  PubMed  Google Scholar 

  20. López-Matamala B, Fajardo M, Estébanez-Montiel B, Blancas R, Alfaro P, Chana M. A new thoracic interfascial plane block as anesthesia for difficult weaning due to ribcage pain in critically ill patients. Med Intensiva. 2014;38(7):463–5.

    Article  PubMed  Google Scholar 

  21. Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014;17(5):E651–3.

    PubMed  Google Scholar 

  22. Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician. 2015;18(3):E421–4.

    PubMed  Google Scholar 

  23. Ohgoshi Y, Yokozuka M, Terajima K. Serratus-intercostal plane block for breast surgery. Masui. 2015;64(6):610–4.

    PubMed  Google Scholar 

  24. Daga V, Narayanan MK, Dedhia JD, Gaur P, Crick H, Gaur A. Cadaveric feasibility study on the use of ultrasound contrast to assess spread of injectate in the serratus anterior muscle plane. Saudi J Anaesth. 2016;10(2):198–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Diéguez P, Fajardo M, López S, Alfaro P. BRILMA methylene blue in cadavers. Anatomical dissection. Rev Esp Anestesiol Reanim. 2016;63(5):307–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Emniyet Street, 16130, Bursa, Turkey

    Korgün Ökmen

  2. Department of Physical Medicine and Rehabilitation, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey

    Burcu Metin Ökmen

Authors
  1. Korgün Ökmen
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Correspondence to Korgün Ökmen.

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Ökmen, K., Ökmen, B.M. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth 31, 579–585 (2017). https://doi.org/10.1007/s00540-017-2364-9

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  • DOI: https://doi.org/10.1007/s00540-017-2364-9

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