Serratus Anterior Plane Block and Intercostal Nerve Block after Thoracoscopic SurgeryFunding Source No funding source.
18 December 2019
24 January 2020
29 March 2020 (online)
Background This study aimed to compare the postoperative analgesic effect between ultrasound-guided serratus anterior plane block (Group S, SAPB) and intercostal nerve block (Group I, ICNB) after single port video-assisted thoracoscopic surgery (S-VATS) in primary spontaneous pneumothorax.
Methods In this prospective randomized controlled study, 54 patients were randomly assigned to two groups. Patients in Group S underwent the SAPB before the surgical drape by an anesthesiologist, and in Group I, ICNBs were performed just before the wound closure after S-VATS by an attending thoracic surgeon. The primary outcome was the numeric pain rating scale (NRS) score given by the patients for pain at the surgical incision site. NRS was assessed during resting and coughing statuses at 3, 6, and 12 hours postoperatively and at the time of the chest tube removal. The secondary outcomes included the number of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid administration until time to chest tube removal.
Results There were no statistical differences between the two groups regarding age, body mass index, duration of operation, duration of anesthesia, and average NRS scores for the assigned time periods. There was no statistical significance in the number of opioid injections; however, NSAIDs were administered 2.8 times per patient in Group I, and 1.9 times per patient in Group S (p = 0.038).
Conclusion In the patients who underwent S-VATS with primary spontaneous pneumothorax, the SAPB provided similar postoperative pain relief with reducing the NSAIDs consumption compared with ICNB.
- 1 Elmore B, Nguyen V, Blank R, Yount K, Lau C. Pain management following thoracic surgery. Thorac Surg Clin 2015; 25 (04) 393-409
- 2 Ismail M, Swierzy M, Nachira D, Rückert JC. Fast-tracking patients through the diagnostic and therapeutic pathways of intrathoracic conditions: the role of uniportal video-assisted thoracic surgery. Thorac Surg Clin 2017; 27 (04) 425-430
- 3 Joshi GP, Bonnet F, Shah R. , et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107 (03) 1026-1040
- 4 Kotzé A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression. Br J Anaesth 2009; 103 (05) 626-636
- 5 Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth 2010; 104 (03) 292-297
- 6 Park JB, Hwang JJ, Lee WS, Kim YH, Lee SA. Postoperative chest tube placement after thoracoscopic wedge resection of lung for primary spontaneous pneumothorax: is it mandatory?. J Thorac Dis 2018; 10 (08) 4812-4818
- 7 Jung H, Oh TH, Cho JY, Lee DH. Mid-term outcomes of single-port versus conventional three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 2017; 50 (03) 184-189
- 8 Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68 (11) 1107-1113
- 9 Okmen K, Okmen BM, Uysal S. Serratus anterior plane (SAP) block used for thoracotomy analgesia: a case report. Korean J Pain 2016; 29 (03) 189-192
- 10 Ökmen K, Metin Ökmen B. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med 2018; 37 (04) 349-353
- 11 Park MH, Kim JA, Ahn HJ, Yang MK, Son HJ, Seong BG. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia 2018; 73 (10) 1260-1264
- 12 Chen G, Li Y, Zhang Y, Fang X. Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial. J Pain Res 2019; 12: 2411-2417
- 13 Reyad RM, Shaker EH, Ghobrial HZ. , et al. The impact of ultrasound-guided continuous serratus anterior plane block versus intravenous patient-controlled analgesia on the incidence and severity of post-thoracotomy pain syndrome: a randomized, controlled study. Eur J Pain 2020; 24 (01) 159-170
- 14 Whitley E, Ball J. Statistics review 4: sample size calculations. Crit Care 2002; 6 (04) 335-341
- 15 Lee H-J, Kim Y-S, Park I. Calculation of sample size in clinical trials. Clin Shoulder Elbow 2013; 16: 53-57
- 16 Moon K-W. R statistics and graphs for medical papers. Seoul: Hannaare; 2015
- 17 R Development Core Team. A language and environment for statistical computing [Internet]. Vienna: R Foundation for Statistical Computing; 2016 [cited 2018 Mar 21]. Available from: http://www.R-project.org/
- 18 Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011; 107 (06) 859-868
- 19 Wang L, Wang Y, Zhang X, Zhu X, Wang G. Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study. J Pain Res 2019; 12: 2231-2238
- 20 Bolotin G, Lazarovici H, Uretzky G, Zlotnick AY, Tamir A, Saute M. The efficacy of intraoperative internal intercostal nerve block during video-assisted thoracic surgery on postoperative pain. Ann Thorac Surg 2000; 70 (06) 1872-1875
- 21 Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg 2005; 80 (04) 1550-1559
- 22 Park CH, Kim DH, Lee JD. , et al. Effect of the preoperative intercostal nerve block in a rat model of postthoracotomy pain. Korean J Pain 2008; 21: 106-111
- 23 Temes RT, Won RS, Kessler RM, Wernly JA. Thoracoscopic intercostal nerve blocks. Ann Thorac Surg 1995; 59 (03) 787-788
- 24 Refai M, Brunelli A, Salati M, Xiumè F, Pompili C, Sabbatini A. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg 2012; 41 (04) 820-822 , discussion 823
- 25 Okur E, Baysungur V, Tezel C. , et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg 2009; 35 (01) 32-35 , discussion 35–36
- 26 Woo WG, Joo S, Lee GD, Haam SJ, Lee S. Outpatient treatment for pneumothorax using a portable small-bore chest tube: a clinical report. Korean J Thorac Cardiovasc Surg 2016; 49 (03) 185-189
- 27 Kim IH, Kang DK, Min HK, Hwang YH. A prospective randomized trial comparing manual needle aspiration to closed thoracostomy as an initial treatment for the first episode of primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 2019; 52 (02) 85-90