Serratus anterior plane block versus intravenous opioid use for acute post-thoracotomy pain

Abstract

Background Inadequate treatment of post-thoracotomy pain can lead to both acute impact on patient comfort and pulmonary function, and long-term pain interfering with patients’ regular activities for a long time. This study aimed to evaluate the analgesic effectiveness of serratus anterior plane block (SAPB) as a regional analgesic procedure in post-thoracotomy pain. Patients and methods In this randomized, prospective, interventional, single-center, and double-blind study, patients were randomly assigned into two groups of 30 patients each. Group A: patients were subjected to standard anesthesia and ultrasound-guided SAPB using 30 ml of 0.25% bupivacaine after induction of anesthesia. In addition, rescue postoperative intravenous opioid analgesia was used when needed to maintain the visual analog scale (VAS) at less than or equal to 3.Group B: standard anesthesia was done, and titrated postoperative intravenous opioid analgesia was used for post-thoracotomy pain relief to maintain the VAS at less than or equal to 3. Our primary outcome was to measure postoperative VAS at rest and on coughing up to 24 h postoperatively. Our secondary outcomes were to measure total intraoperative and postoperative opioid used, to record opioid use over time intervals, time to first postoperative opioid administration, and to assess opioid-related complications, all up to 24 h postoperatively. Results VAS at rest and on coughing up to 6 h postoperatively was significantly less in the SAPB group, and there was no significant difference between both groups from 6 h up to 24 h postoperatively. Total intravenous opioids used, total intraoperative fentanyl, total postoperative morphine, and time-related postoperative morphine up to 6 h postoperatively were significantly less in the SAPB group, and there was no significant difference between both groups from 6 up to 24 h postoperatively. The time to first postoperative opioid use was also significantly longer in the SAPB group. Conclusion Ultrasound-guided SAPB can be an effective technique for post-thoracotomy analgesia with probably better pain control compared with intravenous opioid analgesia alone, with less total opioid use.