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Comparison of efficiency of serratus anterior plane block and thoracic epidural block for thoracotomy analgesia

Yıl 2018, , 156 - 159, 30.11.2018
https://doi.org/10.25000/acem.435367

Öz

Aim: Currently,
regional anesthesia methods are frequently used for post-thoracotomy pain. In
this study, we aimed to compare the efficacy of serratus anterior plane block
and thoracic epidural block for pain after thoracotomy.

Methods: This retrospective
study included 120 patients who underwent thoracotomy. Seventy patients who met
the inclusion criteria were evaluated in two groups as Group E (thoracic
epidural block) (n=37) and Group S (serratus
anterior plane block) (n=33). Postoperative 2nd,
6th, 12th and 24 hour
visual analogue scale scores
and total analgesic consumption for 24 hours were evaluated.
Secondary outcomes were determined as side effects, additional analgesic drug
requirement and complications.

Results: In the comparison between the groups,
there was no statistically significant difference between two groups in terms
of
Postoperative
2nd (p=0.417), 6th (p=0.271), 12th (p=0.734) and 24 hour
(p=0.157) visual analogue scale scores
​​and the amount of total analgesic consumption for 24 hours (p=0.714). There was no statistically significant
difference between two groups with regard to the side effects nausea and vomiting
(p=0.714), pruritus (p=N/A), respiratory depression
(p=N/A) levels.







Conclusion: The results of this study demonstrate that use of serratus
anterior plane block and thoracic epidural block administration has similar outcomes
for post-thoracotomy analgesia. 

Kaynakça

  • 1. Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology.1994;81:737–59.
  • 2. Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. Review articles. J Cardiothorac Vasc Anesth. 2014;28:1048–56.
  • 3. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In: Miller RD, editor. Miller’s anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 1942–2006.
  • 4. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur J Anaesthesiol. 2015;32:812-18.
  • 5. Blanco R. The ‘Pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8.
  • 6. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultra-sound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616-7.
  • 7. Blanco R, Parras T, McDonnell JG, Prats- Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.
  • 8. Hetta DF, Rezk KM. Pectoralis serratus interfascial plane block vs thoracic paravertebral block for unilateral radicalmastectomy with axillary evacuation.J Clin Anesth. 2016,34:91-7
  • 9. [Demirhan A, Gül R, Ganidağlı S, Koruk S, Mızrak A, Şanlı M, et al. Combination of Dexmedetomidine and Tramadol in the Treatment of Pain After Thoracotomy]. GKDA Derg. 2011;17:34-41.
  • 10. Gulbahar G, Kocer B, Muratli SN, Yildirim E, Gulbahar O, Dural K, et al. comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg. 2010;37:467-72.
  • 11. Khalil AE, Abdallah NM, Bashandy GM, Kaddah TAH. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth. 2017;31: 152-58.
  • 12. Lönqvist PA, McKenzie J, Soni AK, Conacher AD. Paravertebral blockade: Failure rate and complications. Anesthesia. 1995;50:813-5.
  • 13. Hards M, Harada A, Neville I, Harwell S, Babar M, Ravalia A, et al. The effect of serratus plane block performed under direct vision on postoperative pain in breast surgery. J Clin Anesth. 2016;34:427-31.
  • 14. Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth.2017;31: 579-85.
  • 15. Bhoi D, Pushparajan HK, Talawar P, Kumar A, Baidya DK. Serratus anterior plane block for breast surgery in a morbidly obese patient. J Clin Anesth. 2016;33:500–1.
  • 16. Ohgoshi Y, Yokozuka M, Terajima K. Serratus-Intercostal Plane Block for Brest Surgery. Masui. 2015;64:610-4
  • 17. 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;10:198-201.
  • 18. Diéguez P, Fajardo M, López S, Alfaro P. BRILMA methylene blue in cadavers. Anatomical dissection. Rev Esp Anestesiol Reanim. 2016;63:307-8.
  • 19. López-Matamala B, Fajardo M, Estébanez-Montiel B, Blancas R, Alfaro P, Chana M. A new thoracic interfascial plane block as anesthesia for difficult weaning due to ribcage pain in critically ill patients. Med Intensiva. 2014;38:463-5.
  • 20. Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014;17:651–3.
  • 21. Ökmen K, Ökmen BM. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med. 2018;37:349-53.

Torakotomi analjezisi için uygulanan serratus anterior alan ve torakal epidural blok etkinliklerinin karşılaştırılması

Yıl 2018, , 156 - 159, 30.11.2018
https://doi.org/10.25000/acem.435367

Öz

Amaç: Post-torakotomi ağrısı için günümüzde rejyonal anestezi
yöntemleri sıklıkla kullanılmaktadır. Bu çalışmada torakotomi sonrası ağrı için
serratus anterior alan bloğunun (SAPB) ve torakal epidural bloğun etkinliğini karşılaştırmayı
amaçladık.

Yöntemler: Bu retrospektif çalışmada torakotomi yapılan 120 hasta
çalışmaya alındı.Dahil etme kriterlerini karşılayan 70 hasta Grup E (torasik
epidural blok) (n=37) ve Grup S (serratus anterior alan blok) (n=33) olmak
üzere iki grupta değerlendirildi. Postoperatif 2., 6., 12. ve 24. saatlerde
görsel analog skala skorları ve 24 saatlik  toplam analjezik tüketimi değerlendirildi.
İkincil sonuçlar yan etkiler, ek analjezik ilaç gereksinimi ve komplikasyon
olarak belirlendi.

Bulgular: Gruplar arasında yapılan
karşılaştırmalarda ameliyat sonrası 2. saat (p=0.417), 6. saat (p=0.271), 12.
saat (p=0.734) ve 24. saat (p=0.157) görsel analog skala skorları ve 24 saatlik
 toplam analjezik tüketimi miktarları (p=0.714)
karşılaştırıldığında, 2 grup arasında istatistiksel olarak anlamlı fark
yoktu.  İki grup arasında yan etkiler, bulantı
ve kusma (p=0.714), kaşıntı (p=N/A), solunum depresyonu (p=N/A) düzeyleri
açısından istatistiksel olarak anlamlı fark yoktu.







Sonuç: Bu çalışmanın sonuçları, serratus anterior alan
bloğu ve torasik epidural blok uygulamasının torakotomi sonrası analjezi için
benzer sonuçlara sahip olduğunu göstermektedir.

Kaynakça

  • 1. Kavanagh BP, Katz J, Sandler AN. Pain control after thoracic surgery. A review of current techniques. Anesthesiology.1994;81:737–59.
  • 2. Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. Review articles. J Cardiothorac Vasc Anesth. 2014;28:1048–56.
  • 3. Slinger PD, Campos JH. Anesthesia for thoracic surgery. In: Miller RD, editor. Miller’s anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 1942–2006.
  • 4. Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial. Eur J Anaesthesiol. 2015;32:812-18.
  • 5. Blanco R. The ‘Pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8.
  • 6. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultra-sound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616-7.
  • 7. Blanco R, Parras T, McDonnell JG, Prats- Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.
  • 8. Hetta DF, Rezk KM. Pectoralis serratus interfascial plane block vs thoracic paravertebral block for unilateral radicalmastectomy with axillary evacuation.J Clin Anesth. 2016,34:91-7
  • 9. [Demirhan A, Gül R, Ganidağlı S, Koruk S, Mızrak A, Şanlı M, et al. Combination of Dexmedetomidine and Tramadol in the Treatment of Pain After Thoracotomy]. GKDA Derg. 2011;17:34-41.
  • 10. Gulbahar G, Kocer B, Muratli SN, Yildirim E, Gulbahar O, Dural K, et al. comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management. Eur J Cardiothorac Surg. 2010;37:467-72.
  • 11. Khalil AE, Abdallah NM, Bashandy GM, Kaddah TAH. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth. 2017;31: 152-58.
  • 12. Lönqvist PA, McKenzie J, Soni AK, Conacher AD. Paravertebral blockade: Failure rate and complications. Anesthesia. 1995;50:813-5.
  • 13. Hards M, Harada A, Neville I, Harwell S, Babar M, Ravalia A, et al. The effect of serratus plane block performed under direct vision on postoperative pain in breast surgery. J Clin Anesth. 2016;34:427-31.
  • 14. Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth.2017;31: 579-85.
  • 15. Bhoi D, Pushparajan HK, Talawar P, Kumar A, Baidya DK. Serratus anterior plane block for breast surgery in a morbidly obese patient. J Clin Anesth. 2016;33:500–1.
  • 16. Ohgoshi Y, Yokozuka M, Terajima K. Serratus-Intercostal Plane Block for Brest Surgery. Masui. 2015;64:610-4
  • 17. 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;10:198-201.
  • 18. Diéguez P, Fajardo M, López S, Alfaro P. BRILMA methylene blue in cadavers. Anatomical dissection. Rev Esp Anestesiol Reanim. 2016;63:307-8.
  • 19. López-Matamala B, Fajardo M, Estébanez-Montiel B, Blancas R, Alfaro P, Chana M. A new thoracic interfascial plane block as anesthesia for difficult weaning due to ribcage pain in critically ill patients. Med Intensiva. 2014;38:463-5.
  • 20. Kunhabdulla NP, Agarwal A, Gaur A, Gautam SK, Gupta R, Agarwal A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014;17:651–3.
  • 21. Ökmen K, Ökmen BM. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med. 2018;37:349-53.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Korgün Ökmen 0000-0001-8546-4661

Yayımlanma Tarihi 30 Kasım 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

Vancouver Ökmen K. Comparison of efficiency of serratus anterior plane block and thoracic epidural block for thoracotomy analgesia. Arch Clin Exp Med. 2018;3(3):156-9.