Serratus anterior plane block for minimal invasive heart surgery

Vivien Berthoud, Omar Ellouze, Maxime Nguyen, Maria Konstantinou, Serge Aho, Ghislain Malapert, Claude Girard, Pierre-Gregoire Guinot, Olivier Bouchot, Belaid Bouhemad, Vivien Berthoud, Omar Ellouze, Maxime Nguyen, Maria Konstantinou, Serge Aho, Ghislain Malapert, Claude Girard, Pierre-Gregoire Guinot, Olivier Bouchot, Belaid Bouhemad

Abstract

Background: Minimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS.

Methods: It's retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France. All patients scheduled for MIHS was included. Data was collected retrospectively. During this period, 20 patients had SAPB and 26 had CWI. SAPB was performed before extubation with a single injection of 0.5 mg/kg of ropivacaïne (5 mg/ml). In the CWI group, catheter was inserted in the subcutaneous space by the surgeon at the end of the procedure. A 10 ml bolus of ropivacaïne (7.5 mg/mL) was followed by a continuous infusion (2 mg/ml) between 7 and 12 ml/h for 48 h. Morphine consumption and visual analog score (VAS) were recorded for 48 h. Length of stay in intensive care unit and hospital was also collected.

Results: Morphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group.

Conclusion: SAPB appears effective in reducing postoperative MIHS pain.

Keywords: Minimal invasive heart surgery; Pain; Post operative; Serratus anterior plane block; Thoracotomy.

Conflict of interest statement

Ethics approval and consent to participate

Consent to participate was waived due to retrospective character of the study. SABP and CWI were realized as routine professional practices in our center. Due to the use of patient data, we submitted our study to the national commission for data protection (CNIL) and obtained authorization which is 2053943 v 0.

Consent for publication

NA

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
SAPB landmarks, punction, and echographic view
Fig. 2
Fig. 2
Morphine consumption during study period

References

    1. Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol. 2010;56(6):455–452. doi: 10.1016/j.jacc.2010.03.053.
    1. Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol. 2011;24(1):8–12. doi: 10.1097/ACO.0b013e3283414175.
    1. Karmakar MK, Ho AMH. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004;14(3):345–342. doi: 10.1016/S1547-4127(04)00022-2.
    1. Pisani MA, Murphy TE, Araujo KLB, et al. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med janv. 2009;37(1):177–173. doi: 10.1097/CCM.0b013e318192fcf9.
    1. Mantz J, Hemmings HC, Boddaert J. Case scenario: postoperative delirium in elderly surgical patients. Anesthesiology. 2010;112(1):189–185. doi: 10.1097/ALN.0b013e3181c2d661.
    1. Fletcher D, Aubrun F. Long texts for the formalized recommendation of experts on management of postoperative pain. Ann Fr Anesth Réanimation. 2009;28(1):1–2. doi: 10.1016/j.annfar.2008.12.001.
    1. Comité douleur-anesthésie locorégionale et le comité des référentiels de la Sfar Formalized recommendations of experts 2008. Management of postoperative pain in adults and children. Ann Fr Anesth Réanimation. 2008;27(12):1035–1041. doi: 10.1016/j.annfar.2008.10.002.
    1. Horlocker TT. Peripheral nerve blocks--regional anesthesia for the new millennium. Reg Anesth Pain Med. 1998;23(3):237–240. doi: 10.1016/S1098-7339(98)90047-5.
    1. Rosen DA, Hawkinberry DW, Rosen KR, et al. An epidural hematoma in an adolescent patient after cardiac surgery. Anesth Analg. 2004;98(4):966–969. doi: 10.1213/01.ANE.0000103267.37895.5B.
    1. Gebhardt R, Mehran RJ, Soliz J, et al. Epidural versus ON-Q local anesthetic-infiltrating catheter for post-thoracotomy pain control. J Cardiothorac Vasc Anesth. 2013;27(3):423–426. doi: 10.1053/j.jvca.2013.02.017.
    1. Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107–1113. doi: 10.1111/anae.12344.
    1. Bhoi D, Pushparajan HK, Talawar P, et al. Serratus anterior plane block for breast surgery in a morbidly obese patient. J Clin Anesth. 2016;33:500–501. doi: 10.1016/j.jclinane.2015.09.004.
    1. Kunhabdulla NP, Agarwal A, Gaur A, et al. A. Serratus anterior plane block for multiple rib fractures. Pain Physician. 2014;17(5):651–653.
    1. Ökmen K, Okmen BM, Uysal S. Serratus anterior plane (SAP) block used for thoracotomy analgesia: a case report. Korean J Pain. 2016;29(3):189–192. doi: 10.3344/kjp.2016.29.3.189.
    1. Takimoto K, Nishijima K, Ono M. Serratus plane block for persistent pain after partial mastectomy and axillary node dissection. Pain Physician. 2016;19(3):481–486.
    1. Berthoud Vivien, Ellouze Omar, Bièvre Thomas, Konstantinou Maria, Jazayeri Saed, Bouchot Olivier, Girard Claude, Bouhemad Belaid. Serratus Anterior Plane Block for Apical TAVR in an Awake Patient. Journal of Cardiothoracic and Vascular Anesthesia. 2018;32(5):2275–2277. doi: 10.1053/j.jvca.2017.12.042.
    1. Hetta DF, Rezk KM. Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation. J Clin Anesth. 2016;34:91–97. doi: 10.1016/j.jclinane.2016.04.003.
    1. Fortier S, Hanna HA, Bernard A, et al. Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block: a randomised, controlled trial of postthoracotomy pain management. Eur J Anaesthesiol. 2012;29(11):524–530. doi: 10.1097/EJA.0b013e328357e5a1.
    1. Daga V, Narayanan MK, Dedhia JD, Gaur P, et al. 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(2):198–201. doi: 10.4103/1658-354X.168825.
    1. Mayes J, Davison E, Panahi P, Patten D, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia. 2016;71(9):1064–1069. doi: 10.1111/anae.13549.
    1. Ökmen Korgün, Metin Ökmen Burcu. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesthesia Critical Care & Pain Medicine. 2018;37(4):349–353. doi: 10.1016/j.accpm.2017.09.005.
    1. Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth. 2017;31(4):579–585. doi: 10.1007/s00540-017-2364-9.
    1. Khalil AE, Abdallah NM, Bashandy GM, et al. Ultrasound-guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth. 2017;31(1):152–158. doi: 10.1053/j.jvca.2016.08.023.
    1. Bossolasco M, Bernardi E, Fenoglio LM. Continuous serratus plane block in a patient with multiple rib fractures. J Clin Anesth. 2017;38:85–86. doi: 10.1016/j.jclinane.2016.12.015.
    1. Madabushi R, Tewari S, Gautam SK, et al. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician. 2015;18(3):E421–E424.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir