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Aims:Chest wall blocks are effective alternatives for postoperative pain control inmitral valve surgery in rightmini?thoracotomy (mini?MVS).We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief aftermini?MVS. Settings and Design: It is a prospective, observational study. Material and Methods: A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini?MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator?free days). Results: The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups (P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group (P = 0.002 and P = 0.048, respectively). Conclusions: ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.
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Objective:To evaluate the effect of general anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block of the lower costal margin in minimally invasive radical resection of esophageal cancer.Methods:Forty patients who underwent thoracolaparoscopic minimally invasive radical esophageal cancer radical resection in the Yuying Children′s Hospital, the Second Affiliated Hospital of Wenzhou Medical University from April to June 2020 were selected. According to the random number table, they were divided into nerve block group and control group, with 20 cases in each group. The general anesthesia was the same in the two groups. The nerve block group was blocked at the serratus anterior plane and the bilateral transversus abdominis plane after the induction of general anesthesia. The intraoperative dosages of propofol, remifentanil, and sufentanil were compared between the two groups. The postoperative extubation time, the time of stay in the postanesthesia care unit (PACU), and the postoperative hospital stay were compared between the two groups. The visual analogue scale (VAS) scores under static and coughing conditions 30 min, 2 h, 4 h, 12 h and 24 h after surgery, and the 24 h postoperative intravenous patient-controlled intravenous analgesia (PCIA) drug dosage and the occurrence of nausea and vomiting were compared between the two groups.Results:The intraoperative dosages of propofol, remifentanil and sufentanil in the nerve block group were lower than those in the control group: (1 262.6 ± 163.8) mg vs. (1 388.3 ± 213.2) mg, (3 834.3 ± 477.3) mg vs. (4 175.2 ± 503.4) mg, (56.3 ± 8.2) mg vs. (66.1 ± 5.3) mg, and the differences were statistically significant ( P<0.05). The postoperative extubation time, PACU stay time and postoperative hospital stay in the nerve block group were significantly shorter than those in the control group: (28.6 ± 12.1) h vs. (42.1 ± 13.7) h, (66.8 ± 21.4) h vs. (89.3 ± 35.4) h, (10.4 ± 2.0) d vs. (14.5 ± 7.0) d, and the differences were statistically significant ( P<0.05). The VAS scores of patients in the nerve block group were lower than those in the control group under static and coughing conditions at 30 min and 2, 4, 12, 24 h after the operation, and the differences were statistically significant ( P<0.05). The ratio of total PCIA compressions/effective compressions within 48 h after the operation of the nerve block group and the total amount of analgesic pump drug infusion at 24 and 48 h after the operation were lower than those in the control group: 1.21 ± 0.19 vs. 1.42 ± 0.20, (39.3 ± 3.2) ml vs. (106.5 ± 7.4) ml, (138.5 ± 9.5) ml vs. (211.9 ± 13.7) ml, and the differences were statistically significant ( P<0.05). The incidence of postoperative nausea and vomiting in the nerve block group were lower than those in the control group: 25.0% (5/20) vs. 65.0% (13/20), 10.0% (2/20) vs. 45.0% (9/20), and the differences were statistically significant ( P<0.05). Conclusions:General anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block can reduce the amount of anesthetics and opioid analgesics in minimally invasive radical resection of esophageal cancer, improve the patient′s recovery quality, enhance the operation post-analgesic effect, and accelerate the patient′s recovery.
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BACKGROUND: In breast surgery, regional anesthesia rather than primary anesthesia has been mainly used for postoperative analgesia. Serratus anterior plane block is a new method for ultrasound-guided thoracic wall block. It is less invasive and relatively safer than conventional regional anesthetic techniques. CASE: We report a case of breast surgery under serratus anterior plane block as primary anesthesia with monitored anesthesia for a 78-year-old patient with a medical history of cardiopulmonary resuscitation due to stress-induced cardiomyopathy caused by pneumonia. CONCLUSIONS: Serratus anterior plane block might be simple and effective technique for breast surgery when a lesion is located on lateral side.
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Aged , Humans , Analgesia , Anesthesia , Anesthesia, Conduction , Breast , Cardiomyopathies , Cardiopulmonary Resuscitation , Methods , Pneumonia , Thoracic WallABSTRACT
Objective To investigate the effect of ultrasound-guided serratus anterior plane (SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n = 25 each) : SAP block group (group N) and control group (group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375％ ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale (VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N (P ＜ 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.
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Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.