Ultrasound-guided serratus anterior plane block for postthoracotomy pain

Background and aims: Thoracotomy is widely recognized as one of the most painful surgical procedures. This form of intensified pain is a matter of high concern to prevent pulmonary complications. Opiates and other weaker analgesics are not sufficiently effective in controlling post-thoracotomy pain. Now, presently there has been an increased interest in the use of regional nerve blocks. Serratus Anterior Plane Block (USG SAPB) is an interfascial block providing paresthesia of T2 to T9 dermatomes of the anterolateral thorax Materials and methods: In this single hospital-based, patient and observer-blinded study, 60 patients scheduled for elective thoracotomy were randomized to receive USG SAPB (n=30) with 0.2% Ropivacaine after induction and 20 minutes before incision or Standard control group “(n=30) that received standard postoperative pain control with intravenous opioids, NSAIDs and acetaminophen (paracetamol). We compared the postoperative pain assessment, hemodynamic parameters and complications, if any, of both the groups at 2nd, 4th, 6th, 8th, 12th, 24th hours. The statistical analyses were done by using the PSW software version 21.0. Data were compared using the Chi-square test, Unpaired t-test and Mann- Whitney U test. Results: The Visual Analogue Scale score was significantly lower in the USG SAPB group than the Standard pain control group at rest and coughing (p<0.001) at 8, 12 and 24th postoperative hours and 6,8,12 and 24th hours, respectively. The need for rescue analgesia was significantly lower in USG SAPB (p=0.046). The hemodynamic parameters were comparable in both groups. Conclusion: The USG SAPB provided prolonged and adequate analgesia and can be used as an adjuvant treatment option for post-thoracotomy.

Keywords: Visual analogue score; serratus anterior plane block; complications; rescue analgesia.