The Anesthetic Effect of Ultrasound-Guided Serratus Anterior Plane Block in Arthroscopic Shoulder Surgery and Its Effect on Postoperative Analgesia

Hao Zhu, Chao Zhang, Caoxin Yan, Hao Zhu, Chao Zhang, Caoxin Yan

Abstract

Objective: To investigate the anesthetic effect of anterior serratus muscle plane block under ultrasound guidance in arthroscopic shoulder surgery and its effect on postoperative analgesia.

Methods: A total of 94 patients who received arthroscopic shoulder surgery in our hospital were selected as the research subjects, and they were divided into a control group and a study group according to the random number table method. The control group underwent brachial plexus block under ultrasound guidance, and the study group underwent anterior serratus plane block under ultrasound guidance. The visual analogue score (VAS) of pain at each time point, intraoperative anesthetic dosage, the use of postoperative analgesic, pain mediators and oxidative stress factors before and after surgery, and the occurrence of adverse reactions were compared between the two groups after surgery.

Results: At 6, 12, 48, and 72 h after surgery, there was no obvious difference in the VAS score between the two groups (P > 0.05); 24 h after surgery, the VAS score of the study group was significantly lower than that of the control group (P < 0.05). The intraoperative dosage of propofol and remifentanil in the study group was significantly lower than that in the control group (P < 0.05). The number of effective compressions of analgesic pump and the total amount of sufentanil in the study group were significantly lower than those in the control group within 48 hours after operation, and the time of first compressions of analgesic pump was significantly longer than that in the control group (P < 0.05). Before surgery, there were no significant differences in CGRP, NPY, and MDA levels and SOD enzyme activity between the two groups (P > 0.05). After surgery, the levels of pain mediators CGRP and NPY in the study group were lower than those in the control group (P < 0.05). The level of MDA was lower than that of the control group, and SOD enzyme activity was higher than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).

Conclusion: Ultrasound-guided anterior serratus plane block for arthroscopic shoulder surgery has a good anesthesia effect and long action time. It can significantly reduce the dosage of opioids, enhance the postoperative analgesic effect, effectively inhibit postoperative pain and oxidative stress reaction, and has good safety.

Conflict of interest statement

The authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Copyright © 2022 Hao Zhu et al.

Figures

Figure 1
Figure 1
Flow diagram of trial.

References

    1. Hu Y. H., Yang C. H., Li X., Lv H. B. Analysis of clinical therapeutic effect of arthroscopic operation for treatment of patients with rotator cuff tears. Chin J TCM WM Crit Care . 2018;24(3):288–291.
    1. Demir U., Ince I., Aksoy M., et al. The effect of pre-emptive dexketoprofen administration on postoperative pain management in patients with ultrasound guided interscalene block in arthroscopic shoulder surgery. Journal of Investigative Surgery . 2021;34(1):82–88. doi: 10.1080/08941939.2019.1576809.
    1. Li W., Chen Y., Mu Y. Application of ultrasound guided brachial plexus block and superficial cervical plexus block combined with general anesthesia in shoulder arthroscopy. Shanghai Med J . 2018;41(11):47–51.
    1. Codding J. L., Getz C. L. Pain management strategies in shoulder arthroplasty. Orthopedic Clinics of North America . 2018;49(1):81–91. doi: 10.1016/j.ocl.2017.08.010.
    1. Zhang L., Lin X., Zhang H. Comparison of postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery. J Clin Anesthesiology . 2019;35(1):49–53.
    1. Shang L. H., Wang X. Y., Xiao Z. N., Long B. Advance in the ultrasound-guided serratus anterior plane block. Chinese Journal of Advanced Medical Practitioners . 2018;35(1):277–279.
    1. van Erp J. H. J., Ostendorf M., Lansdaal J. R. Shoulder surgery in beach chair position causing perioperative stroke: four cases and a review of the literature. Journal of Orthopaedics . 2019;16(6):493–495. doi: 10.1016/j.jor.2019.05.009.
    1. Park M. H., Kim J. A., Ahn H. J., Yang M. K., Son H. J., Seong B. G. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia . 2018;73(10):1260–1264. doi: 10.1111/anae.14424.
    1. Wang X. W., Sun T. S., Zhang J. Z. Effect of American Society of Anesthesiologists grading on prognosis of elderly patients with hip fracture. Chinese Journal of Traumatology . 2020;36(1):51–57.
    1. Chen Y. Effects of ropivacaine and midazolam combined with sufentanil on pain visual analogue scale in obstetrics and gynecology anesthesia. China Prac Med . 2018;13(13):11–13.
    1. Teken E., Ksuz G., Ksuz H., et al. Analgesic efficacy of serratus anterior plane block in rib fractures pain: A randomized controlled trial. American Journal of Emergency Medicine . 2020;41(2):21–24. doi: 10.1016/j.ajem.2020.12.041.
    1. Luo C., Wang D. M., Wang Q. M. The effect of brachial plexus block combined with general anesthesia in shoulder arthroscopy. Chin J of Clinical Rational Drug Use . 2020;13(2C):89–91.
    1. Wei Y., Guo X. Y., Yang L., Rong Y L, Xu C Y, Li M. Effects of continuous interscalene brachial plexus block plus general General anesthesia alone on perioperative management of arthroscopic rotator cuff repair surgery. National Medical Journal of China . 2012;92(33):2327–2330.
    1. Ahiskalioglu A., Alici H. A., Yayik A. M., Celik M., Oral Ahiskalioglu E. Ultrasound guided serratus plane block for management of acute thoracic herpes zoster. Anaesthesia Critical Care & Pain Medicine . 2017;36(5):323–324. doi: 10.1016/j.accpm.2017.01.008.
    1. Chan J. H., Perez H., Lee H., Saltzman M., Marra G. Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi-beach chair Position. Journal of Shoulder and Elbow Surgery . 2020;29(1):79–85. doi: 10.1016/j.jse.2019.05.022.
    1. Wang H. J., Liu Y., Ge W. W., et al. Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy. National Medical Journal of China . 2019;99(23):1809–1813.
    1. Takimoto K., Kaoru N., Ono M. Serratus plane block for persistent pain after partial mastectomy and axillary node dissection. Pain Physician . 2016;19(3):E481–E486. doi: 10.36076/ppj/2019.19.e481.
    1. Han C., Ren H. F., Zhou M. M. Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy. Journal of Clinical Anesthesia . 2016;32(12):1173–1176.
    1. Wang Y. Q., Mao M. Effect of ultrasound-guided serratus anterior plane block on the pain, inflammation and oxidation after radical mastectomy. Journal of Hainan Medical University . 2018;24(14):1375–1378.
    1. Hanley C., Wall T., Bukowska I., et al. Ultrasound‐guided continuous deep Serratus anterior plane block versus Continuous Thoracic Paravertebral Block Study on the effect of analgesia on thoracic surgery. European Journal of Pain . 2020;24(4):34–36. doi: 10.1002/ejp.1533.
    1. Liu X., Wu X. M., Zhu J. Effect of ultrasound-guided anterior serratus plane block on postoperative analgesia in patients undergoing thoracotomy. The Journal of Practical Medicine . 2018;34(19):100–103.

Source: PubMed

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