Serratus Anterior Plane Block: A Better Modality of Pain Control after Pectus Excavatum Repair.

Ka, Eun Seok; Rim, Gong Min; Kang, Seungyoun; Bae, Saemi; Jang, Il-Tae; Park, Hyung Joo

Ka, Eun Seok; Rim, Gong Min; Kang, Seungyoun; Bae, Saemi; Jang, Il-Tae; Park, Hyung Joo.

Afiliación

Ka ES; Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Rim GM; Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea.
Kang S; Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea.
Bae S; Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea.
Jang IT; Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea.
Park HJ; Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea.

J Chest Surg ; 57(3): 291-299, 2024 May 05.

Article en En | MEDLINE | ID: mdl-38472120

ABSTRACT

ABSTRACT

Background:

Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods.

Methods:

We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME).

Results:

Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N 108.53, group S 16.61; p<0.01).

Conclusion:

SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

Palabras clave

Cryoanlgesia; Minimally invasive repair of pectus excavatum; Pectus excavatum; Postoperative pain; Serratus anterior plane block

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Chest Surg Año: 2024 Tipo del documento: Article Pais de publicación: