The effect of ultrasound-guided low serratus anterior plane block on laparoscopic cholecystectomy postoperative analgesia

Abstract Objective To investigate whether perioperative ultrasound-guided serratus anterior plane block (SAPB) combined with general anesthesia is more effective and safer than current analgesic techniques for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). Methods PubMed, the Cochrane Library, and EMBASE were searched for clinical trials published up to July 31, 2019. Outcomes, including operative duration, postoperative pain scores, postoperative analgesia use, patient satisfaction with analgesia, time to chest tube removal, length of stay, and adverse effects were analyzed. Results Four clinical trials, including 262 patients, met inclusion criteria. Ultrasound-guided SAPB reduced pain scores at zero, 15, 30, 45, and 60 minutes in the postoperative anesthesia care unit (all P < 0.05) and at one, two, six, 12, and 24 hours in the ward (all P < 0.001). Additionally, postoperatively, morphine consumption at 15 and 30 minutes, overall morphine consumption, and total consumption (morphine plus tramadol) were significantly lower in the SAPB cohort (P < 0.05). Similarly, postoperative tramadol consumption at one, two, six, 12, and 24 hours was also lower in this cohort (all P < 0.05). The postoperative consumption of fentanyl, tramadol, and total morphine in patient-controlled analgesia (PCA) at 24 hours was significantly reduced (P < 0.05). Moreover, SAPB provided better patient satisfaction with analgesia (P = 0.0038). However, no statistically significant difference was found in duration of operation, time to chest tube removal, length of stay, or side effects (all P > 0.05). Conclusions Perioperative ultrasound-guided SAPB combined with general anesthesia provided more effective postoperative analgesia after VATS. However, no significant advantage was found regarding side effects.

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Comparative Study between the Effect of Ultrasound Guided Pectoral Nerve Block (PEC 1) versus Serratus Anterior Plane Block (SAPB) For Postoperative Analgesia in Modified Radical Mastectomy

QJM ◽

10.1093/qjmed/hcab086.061 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Abd El-Rahman Abd El-Megeed ◽

Alaa Eid Mohamed Hassan ◽

Tarek Mohamed Ahmed Ashour ◽

Ahmed Mounir Ahmed Youssef

Keyword(s):

Nerve Block ◽

Postoperative Analgesia ◽

Radical Mastectomy ◽

Modified Radical Mastectomy ◽

Ultrasound Guided ◽

Serratus Anterior ◽

Female Population ◽

Pectoral Nerve ◽

Group I ◽

Anterior Plane

Abstract Background Breast cancer has continued to be the most common cancer afflicting women, accounting for 31% of all new cancer cases in the female population. Every year, thousands of patients undergo surgery in the region of the breast and axilla. Surgery is one of the mainstays of treatment, and a procedure called modified radical mastectomy (MRM) is now a standard surgical treatment for earlystage breast cancers. Objectives The aim of this work is to evaluate the Effectiveness of Ultrasound Guided Pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in Modified Radical Mastectomy Patients and Methods After obtaining approval from the medical ethical committee in Ain Shams University This study was conducted in the operating theatres of Ain Shams University Hospitals. It included Thirty Female patients undergoing Modified Radical Mastectomy were divided randomly into two groups, each group consisted of 15 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results The two groups were adequately monitored and assessed post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first for analgesic need and total consumption of opioid and analgesic in the 1st 24 postoperative hours. Demographic data and post operative hemodynamics were also assessed. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after Modified Radical Mastectomy under general anesthesia, compared to PEC 1 block.

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Serratus anterior plane block for upper abdominal incisions

Anaesthesia and Intensive Care ◽

10.1177/0310057x19842461 ◽

2019 ◽

Vol 47 (2) ◽

pp. 197-199 ◽

Cited By ~ 3

Author(s):

Akhilesh K Tiwari ◽

Antimony A Mar ◽

Mark A Fairley

Keyword(s):

Chest Wall ◽

Postoperative Analgesia ◽

Anaesthetic Techniques ◽

Early Mobilisation ◽

Ultrasound Guided ◽

Serratus Anterior ◽

Neuraxial Blockade ◽

Potential Alternative ◽

Upper Abdominal ◽

Anterior Plane

Regional anaesthetic techniques for patients undergoing laparotomy have been shown to provide optimal postoperative analgesia and allow early mobilisation, and thus, enhance recovery. The serratus anterior plane block, first documented in 2013, has been suggested as a potential alternative to thoracic paravertebral and central neuraxial blockade for chest wall and upper abdominal incisions as it can provide analgesia from T2 to T9. Although there are published cases of this block being used for chest wall analgesia, there are currently no published cases of this block being used for abdominal incisions. We report our experience with two patients, using ultrasound-guided serratus anterior plane blockade with catheter insertion following laparotomy.

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