Clinical application of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block in right-thoracoscopic minimally invasive cardiac surgery: a retrospective cohort study

Objectives: This study aimed to investigate the effects of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block on the post-operative rehabilitation of patients undergoing right-sided thoracoscopic minimally invasive cardiac surgery, as well as the safety and feasibility of the clinical application of this technique. Background: Regional nerve block has previously been used in cardiac surgery to reduce intraoperative opioid use and promote anesthesia in fast-track and ultra-fast-track cardiac surgery. However, the clinical application of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) in minimally invasive cardiac surgery under thoracoscopy has not been reported. Methods: A total of 102 patients who underwent right-sided thoracoscopic minimally invasive heart valve surgery in our center from January 2021 to August 2021 were enrolled and divided into two groups: an ultrafast channel cardiac anesthesia assisted by serratus anterior plane block (SAPB-GA) group (n=40) and a conventional general anesthesia (GA) group (n=62). The effects of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) on post-operative rapid recovery as well as the safety and feasibility of its clinical application were compared and analyzed. Results: Compared to the GA group, the intraoperative use of sufentanil in the SAPB-GA group was significantly reduced (66.25±1.025, 283.31±11.362, P<0.001); the incidence of postoperative analgesia in ICU was significantly decreased (17%, 48.8%, P<0.001); the incidence of postoperative NRS≥3 in ICU was significantly decreased (15%, 37.1%, P = 0.016); and the postoperative extubation time (1(1-1), 13.84 (10.25-18.36), P<0.001), ICU stay time (28.58±2.838, 61.69±4.125, P<0.001) and postoperative hospital stay (8.08±0.313, 9.74±0.356, P=0.02) were significantly shortened; and the 24 h postoperative thoracic blood drainage was significantly reduced (209.63±25.645, 318.23±20.713, P<0.001). No statistical difference was observed in the incidence of postoperative nausea, vomiting and atelectasis between the two groups (all P>0.05). Both of the groups reported no postoperative cardiovascular events. Conclusions: Ultrafast channel cardiac anesthesia assisted by SAPB could promote the rapid postoperative recovery of patients undergoing minimally invasive cardiac surgery under a thoracoscope. This approach is safe and feasible in the clinic.

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

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).

Serratus anterior plane block for cardiothoracic surgeries: a meta-analysis of randomized trials

Background Comparison of serratus anterior plane block to different analgesic methods for anterolateral thoracic wall incisions. Meta-analysis was used to address this concern. Authors systemically searched the MEDLINE, EMBASE, PubMed, and Cochrane databases to identify all published randomized and prospective clinical trials, comparing the SAPB with other methods that used for analgesia in different thoracic surgical procedures and trauma. Results Ten studies were identified for inclusion in this study, involving a total of 735 patients. Meta-analysis showed that, compared with thoracic wall analgesia and PCA methods, the SAPB group resulted in a significant decrease in pain scores, significant decrease in consumption of analgesic drugs, and a significant decrease in the incidence of nausea and vomiting with no difference in the rate of hypotension. Conclusions The use of SAPB in cardiothoracic surgery and trauma is a safe and effective option for thoracic analgesia.

Blok Serratus Anterior Plane pada Operasi Modified Radical Mastectomy

Latar belakang:Nyeri pascaoperasi payudara dapat memperburuk keluaran klinis jika tidak ditangani dengan optimal. Modalitas analgesia yang biasa digunakan untuk nyeri pascaoperasi payudara meliputi pemberian opioid dan anestesi regional. Namun, kedua modalitas ini dapat menimbulkan efek samping atau komplikasi yang signifikan. Blok serratus anterior plane (SAP) merupakan prosedur baru yang relatif lebih mudah dilakukan dan aman bila dibandingkan dengan modalitas lainnya.Kasus: Kami melaporkan 2 pasien yang menjalani prosedur blok SAP pada operasi modified radical mastectomy (MRM). Pasien 2 diberikan rescue analgesia selama masa intraoperatif. Pemberian opioid pascaoperasi tidak melebihi 24 jam pada kedua pasien. Penilaian nyeri menggunakan Numeric Rating Scale (NRS) menunjukkan nyeri pascaoperatif yang minimal. Tidak ada efek samping yang ditemukan selama masa pemantauan 24 jam.Pembahasan: Blok SAP relatif mudah dilakukan, memiliki tingkat keberhasilan yang tinggi, dan komplikasi minimal jika dibandingkan dengan prosedur lain. Blok SAP memberikan efek analgesia pada thoraks bagian lateral yang dapat bertahan hingga 12 jam pascaoperasi. Studi-studi terdahulu telah melaporkan kegunaannya dalam mengurangi kebutuhan opioid intraoperatif dan pascaoperatif, yang sesuai dengan hasil yang ditemukan pada laporan kasus ini.Kesimpulan: Blok SAP dapat menjadi salah satu modalitas yang efektif dan aman dalam mengelola nyeri pasien yang menjalani operasi MRM.