Serratus Anterior Plane Block Versus Intercostal Nerve Block for Postoperative Analgesia

Serratus Anterior Plane Block vs. Intercostal Nerve Block for Postoperative Analgesic Effect After Video-assisted Thoracoscopic Lobectomy: A Randomized Prospective Study

A prospective randomized controlled study was undertaken to compare the postoperative analgesic effect between ultrasound-guided serratus anterior plane block and intercostal nerve block after video-assisted thoracoscopic lobectomy.

Post-thoracotomy pain is one of the most notorious postsurgical pains that one can experience. The pain is known to last for an extensive period of time with significantly high intensity. In field of thoracic surgery, video-assisted thoracoscopic surgery has been played an important role in alleviating the postoperative pain. In field of anesthesiology, various attempts to alleviate post-thoracotomy pain have been tried along advancement of thoracic surgical techniques. It began with postoperative medication of non-steroid anti-inflammatory drugs, opioids and progressed into implementations such as local analgesia, thoracic epidural block, paravertebral block, intercostal nerve block, interpleural block and serratus anterior plane block. Many analgesic methods have been applied to alleviate postoperative pain in patients who have undergone thoracoscopic surgeries. However, there are no prospective randomized controlled studies between intercostal nerve block and serratus anterior plane block in video-assisted thoracoscopic lobectomy. The main purpose of this study is to compare and analyze the effects between conventional intercostal nerve block and newly introduced serratus anterior plane block in lung cancer patients who have undergone video-assisted thoracoscopic lobectomy. This prospective study will discover the efficacy and differences between two methods.

Serratus Anterior Plane Block was performed just before the start of surgery after anesthetic induction through ultrasound-guidance. 20ml of 0.375% ropivacaine was slowly injected between the fascia of serratus anterior and latissimus dorsi near 5th rib.

Intercostal Nerve Block was performed just before closing the surgical incision while looking directly at the affected intercostal space. 10ml of 0.375% ropivacaine was delivered evenly at anterior and posterior intercostal spaces from the port site.

Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable)

Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable)

Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable)

Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable)

Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable)

If the participant has additional analgesic requirement postoperatively, ketorolac 30mg will be injected intravenously when numeric rating scale score is measured as 4-5, and fentanyl 50# is injected when numeric rating scale score is over 6.

If the participant has additional analgesic requirement postoperatively, ketorolac 30mg will be injected intravenously when numeric rating scale score is measured as 4-5, and fentanyl 50# is injected when numeric rating scale score is over 6.

Inclusion Criteria: lung cancer American Society of Anesthesiologists (ASA) I-III class Video-assisted thoracoscopic lobectomy Exclusion Criteria: previous history of allergy to local anesthetics psychological disorder chronic analgesics or sedatives use coagulopathy The presence of systemic infection or local infection at injection site Pregnancy