Thorac Cardiovasc Surg 2021; 69(06): 570-576
DOI: 10.1055/s-0040-1715491
Original Thoracic

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

1   Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
,
Sibel Seçkin Pehlivan
1   Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
,
Ömer Faruk Demir
2   Department of Thoracic Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
› Author Affiliations

Abstract

Background Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques.

Methods A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30 mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded.

Results During the first 24 hours, VAS values were significantly lower in the ESPB group (p < 0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours (p < 0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group (p < 0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups.

Conclusion ESPB was more effective compared with SAPB in postoperative thoracic pain management.

Financial disclosure

No external funding.




Publication History

Received: 28 April 2020

Accepted: 26 June 2020

Article published online:
25 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg 2001; 72 (02) 362-365
  • 2 Neustein SM, McCormick PJ. Postoperative analgesia after minimally invasive thoracoscopy: what should we do?. Can J Anaesth 2011; 58 (05) 423-425 , 425–427
  • 3 Peng Z, Li H, Zhang C, Qian X, Feng Z, Zhu S. A retrospective study of chronic post-surgical pain following thoracic surgery: prevalence, risk factors, incidence of neuropathic component, and impact on quality of life. PLoS One 2014; 9 (02) e90014
  • 4 Wildgaard K, Iversen M, Kehlet H. Chronic pain after lung transplantation: a nationwide study. Clin J Pain 2010; 26 (03) 217-222
  • 5 Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. J Cardiothorac Vasc Anesth 2014; 28 (04) 1048-1056
  • 6 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
  • 7 Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev 2016; 2: CD009121
  • 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 Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician 2015; 18 (03) E421-E424
  • 10 Gaballah KM, Soltan WA, Bahgat NM. Ultrasound-guided serratus plane block versus erector spinae block for postoperative analgesia after video-assisted thoracoscopy: a pilot randomized controlled trial. J Cardiothorac Vasc Anesth 2019; 33 (07) 1946-1953
  • 11 Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med 2019; 7 (08) 174
  • 12 Taketa Y, Irisawa Y, Fujitani T. Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med 2019; rapm-2019-100827
  • 13 Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth 2017; 31 (04) 579-585
  • 14 Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth 2017; 31 (01) 152-158
  • 15 Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41 (05) 621-627
  • 16 Saad FS, El Baradie SY, Abdel Aliem MAW, Ali MM, Kotb TAM. Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for perioperative analgesia in thoracotomy. Saudi J Anaesth 2018; 12 (04) 565-570
  • 17 Dautzenberg KHW, Zegers MJ, Bleeker CP. et al. Unpredictable injectate spread of the erector spinae plane block in human cadavers. Anesth Analg 2019; 129 (05) e163-e166
  • 18 Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med 2018; 43 (06) 567-571
  • 19 Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med 2018; 43 (07) 756-762
  • 20 Otero PE, Fuensalida SE, Russo PC, Verdier N, Blanco C, Portela DA. Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model. Reg Anesth Pain Med 2020; 45 (03) 198-203
  • 21 Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: a randomized controlled trial. J Clin Anesth 2020; 59: 84-88
  • 22 Diéguez P, Fajardo M, López S, Alfaro P. BRILMA methylene blue in cadavers. Anatomical dissection. Rev Esp Anestesiol Reanim 2016; 63 (05) 307-308
  • 23 Daga V, Narayanan MK, Dedhia JD, Gaur P, Crick H, Gaur A. Cadaveric feasibility study on the use of ultrasound contrast to assess spread of injectate in the serratus anterior muscle plane. Saudi J Anaesth 2016; 10 (02) 198-201
  • 24 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
  • 25 Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician 2014; 17 (05) E651-E653
  • 26 Mayes J, Davison E, Panahi P. et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia 2016; 71 (09) 1064-1069
  • 27 Hanley C, Wall T, Bukowska I. et al. Ultrasound-guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic-assisted thoracic surgery. Eur J Pain 2020; 24 (04) 828-838 ; [Epub ahead of print] 10.1002/ejp.1533
  • 28 Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 2011; 66 (11) 1023-1030