The Effect of the Ultrasound-guided Serratus Anterior Plane Block in Combinaison With Thoracic Paravertebral cathéter Versus Thoracic Paravertebral Cather for Perioperative Analgesia in Thoracic Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background The subcutaneous implantable cardioverter defibrillator (S-ICD) has now become a well-recognised alternative to traditional devices and can be used as a first-line option, avoiding the risks associated with a transvenous lead. Standard implantation is either performed under general anaesthesia or under sedation. Ultrasound-guided serratus anterior plane block (SAPB) has recently been introduced to provide periprocedural anaesthesia and analgesia. Purpose To assess whether SAPB reduces periprocedural analgesia/anaesthesia and post-operative analgesia in S-ICD implantation compared with standard perioperative analgesia/anaesthesia. Methods One hundred and twenty patients eligible for ICD implantation for standard indications were offered a S-ICD over a five-year period (2014-2019) at a single tertiary cardiac centre. From July 2014 to September 2018, consecutive cases were performed with standard analgesia/anaesthesia and performed using a standard two-incision technique. From October 2018 onwards, SAPB was performed in addition to standard perioperative analgesia/anaesthesia. This involved ultrasound-guided infiltration of 50ml prilocaine into the interfascial plane between the serratus anterior muscle and latissimus dorsi at the mid axillary line over the level of the 5th rib. Collection of data was performed at the six-week follow up with all data obtained from routinely collected local registry. Results The mean age at implant was 52.0 years (+15.9 years) and 102 (85.0%) were male. The mean body mass index was 27.9 (+5.2). 85 (70.8%) had a primary prevention indication. 64 (52.3%) patients had a left ventricular ejection fraction (LVEF) of <35%. 79 (65.8%) patients underwent standard implantation without SAPB (SAPB-) and 41 (34.2%) patients with SAPB (SAPB+). There were no significant differences in age, sex, BMI, left ventricular ejection fraction, comorbidities, aetiology and indication between SAPB- and SAPB+ cohorts. In the SAPB+ cohort, a greater proportion were performed using conscious sedation (97.5% vs 84.8%; p = 0.036) with a lower required dose of midazolam (3.3mg vs 6.4mg; p < 0.001). 34 (83%) patients in the SABP+ cohort required no analgesia at discharge compared for 42 (53.2%) in the SAPB- cohort (p = 0.042). There was a trend towards lesser use of periprocedural morphine (6.2mg vs 7.4mg; p = 0.071) and reduced hospital stay (0.7 days vs 1.1 days; p = 0.102) in the SAPB+ cohort. The use of SAPB did not significantly increase total procedural time (63mins vs 57mins; p = 0.110), defined as the total duration for SAPB administration and S-ICD implantation. There were no periprocedural complications and no complications at follow up. Conclusion The use of SAPB significantly reduces the dose of sedation required for S-ICD implantation as well as the need for analgesia at discharge without a significant impact on procedure duration.

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Ultrasound-guided parasternal Pecs block: a new and useful supplement to Pecs I and serratus anterior plane blocks

10.21466/ac.aaaiiap.2016 ◽

2016 ◽

Author(s):

Dr Christian Kruse Hansen ◽

◽

Dr Mette Dam ◽

Dr Troels Dirch Poulsen ◽

Dr Per-Arne Lönnqvist ◽

...

Keyword(s):

Ultrasound Guided ◽

Serratus Anterior ◽

Anterior Plane

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Ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy. A randomized controlled trial

Egyptian Journal of Anaesthesia ◽

10.1080/11101849.2021.1959257 ◽

2021 ◽

Vol 37 (1) ◽

pp. 356-363

Author(s):

Bassant Mohamed Abdelhamid ◽

Samuel Samy ◽

Ahmed Abdalla ◽

Ahmed Saad ◽

Mohamed Ollaek ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Radical Mastectomy ◽

Modified Radical Mastectomy ◽

Ultrasound Guided ◽

Serratus Anterior ◽

Randomized Controlled ◽

Anterior Plane

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Ultrasound-guided Serratus Anterior Plane Block Versus Thoracic Paravertebral Block on Alleviating the Acute and Chronic Pain Following the Video-assisted Thoracic Surgery: a Prospective, Randomized, Double-blinded Non-inferiority Clinical Trial

10.21203/rs.3.rs-1142148/v1 ◽

2021 ◽

Author(s):

Yan Wang ◽

Jing Hao ◽

Simin Huang ◽

Xiaoping Gu ◽

Zhengliang Ma

Keyword(s):

Clinical Trial ◽

Chronic Pain ◽

Thoracic Surgery ◽

Ultrasound Guided ◽

Video Assisted Thoracic Surgery ◽

Video Assisted ◽

Vas Scores ◽

Secondary Outcomes ◽

Double Blinded ◽

Anterior Plane

Abstract Background: The anesthetic efficacy of ultrasound-guided serrate anterior plane block (SAPB) on alleviating postoperative acute and chronic pain has been well concerned. The present study aims to compare the efficacy between ultrasound-guided SAPB and thoracic paravertebral block (PVB) on alleviating both acute pain and chronic pain following the video-assisted thoracic surgery. Methods: It was a prospective, randomized, double-blinded non-inferiority clinical trial involving 99 patients with lung nodules receiving video-assisted thoracic surgery with ultrasound-guided SAPB (SAPB group) or PVB (PVB group) on T4 and T7 vertebra using 0.375% ropivacaine at 2 mg/kg. The Visual Analogue Scale (VAS) scores at both rest and cough at 24 h postoperatively were graded as the primary outcome. Besides, secondary outcomes included the incidence of chronic pain at 3 and 6 months postoperatively, VAS scores at rest and cough at 1, 6, 12 and 48 h postoperatively, consumptions of fentanyl and remifentanyl, and the pressing times of the patient-controlled analgesia (PCA) pump. Baseline characteristics, surgery characteristics and primary and secondary outcomes between groups were compared. Results: A total of 92 eligible patients were recruited, including 46 in SAPB group and 46 in PVB group. Baseline and surgery characteristics between groups were comparable (all P>0.05). No significant differences in VAS scores at rest and cough at 1 h, 6 h, 12 h, 24 h, 48 h, 3 months and 6 months postoperatively between SAPB group and PVB group were detected (all P>0.05). Conclusion: The anesthetic efficacy of ultrasound-guided SAPB was not inferior to PVB on alleviating postoperative acute and chronic pain following the video-assisted thoracic surgery.Trial registration number: retrospective registered in the Chinese Clinical Trial Registry (ChiCTR2100050991, http://www.chictr.org.cn, 09/09/2021, Yan Wang, MD).

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