A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery.
Adult cardiac surgery
intercostal nerve block
pectoral nerve block
postoperative pain
serratus anterior plane block
thoracotomy
Journal
Indian journal of anaesthesia
ISSN: 0019-5049
Titre abrégé: Indian J Anaesth
Pays: India
ID NLM: 0013243
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
17
05
2020
revised:
01
07
2020
accepted:
26
08
2020
entrez:
5
2
2021
pubmed:
6
2
2021
medline:
6
2
2021
Statut:
ppublish
Résumé
Enhanced recovery after cardiac surgery is centred around multimodal analgesia which is becoming increasingly feasible with the advent of safer regional analgesic techniques such as fascial plane blocks. We designed this prospective, single-blind, randomised controlled study to compare the efficacy of serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for post-thoracotomy analgesia in cardiac surgery. 100 adults posted for cardiac surgery through a thoracotomy were randomly allocated to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after completion of surgery. Postoperatively, intravenous (IV) paracetamol was used for multimodal and fentanyl was employed as rescue analgesia. Visual analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours post-extubation. The early mean VAS scores at 2, 4 and 6 hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12 hours) was significantly lower in the SAPB and Pecs II group compared with that of the ICNB group ( SAPB and Pecs II blocks are simple single-shot effective alternatives to ICNB with a prolonged analgesic duration following thoracotomy and can potentially enhance pain-free recovery after cardiac surgery.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Enhanced recovery after cardiac surgery is centred around multimodal analgesia which is becoming increasingly feasible with the advent of safer regional analgesic techniques such as fascial plane blocks. We designed this prospective, single-blind, randomised controlled study to compare the efficacy of serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for post-thoracotomy analgesia in cardiac surgery.
METHODS
METHODS
100 adults posted for cardiac surgery through a thoracotomy were randomly allocated to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after completion of surgery. Postoperatively, intravenous (IV) paracetamol was used for multimodal and fentanyl was employed as rescue analgesia. Visual analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours post-extubation.
RESULTS
RESULTS
The early mean VAS scores at 2, 4 and 6 hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12 hours) was significantly lower in the SAPB and Pecs II group compared with that of the ICNB group (
CONCLUSION
CONCLUSIONS
SAPB and Pecs II blocks are simple single-shot effective alternatives to ICNB with a prolonged analgesic duration following thoracotomy and can potentially enhance pain-free recovery after cardiac surgery.
Identifiants
pubmed: 33542564
doi: 10.4103/ija.IJA_566_20
pii: IJA-64-1018
pmc: PMC7852449
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1018-1024Informations de copyright
Copyright: © 2020 Indian Journal of Anaesthesia.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
J Anesth. 2017 Aug;31(4):579-585
pubmed: 28447227
Indian J Anaesth. 2011 Mar;55(2):104-10
pubmed: 21712863
Rev Esp Anestesiol Reanim. 2012 Nov;59(9):470-5
pubmed: 22939099
J Clin Anesth. 2020 Mar;60:8
pubmed: 31430647
Anesthesiology. 1994 Sep;81(3):737-59
pubmed: 8092520
Indian J Anaesth. 2018 Jun;62(6):436-442
pubmed: 29962525
J Cardiothorac Vasc Anesth. 2019 Feb;33(2):532-546
pubmed: 30529177
Saudi J Anaesth. 2018 Oct-Dec;12(4):565-570
pubmed: 30429738
Anaesthesia. 2013 Nov;68(11):1107-13
pubmed: 23923989
Can J Anaesth. 2019 Oct;66(10):1268-1269
pubmed: 31388837
J Cardiothorac Vasc Anesth. 2020 Feb;34(2):567-568
pubmed: 31416673
Clin J Pain. 2017 Jul;33(7):604-610
pubmed: 27841838
Eur J Cardiothorac Surg. 2002 Jun;21(6):1115-9
pubmed: 12048095
Mo Med. 2019 Jan-Feb;116(1):41-44
pubmed: 30862984
Indian J Anaesth. 2019 Mar;63(3):231-234
pubmed: 30988539
Reg Anesth Pain Med. 2018 Jul;43(5):480-487
pubmed: 29932431
Anesth Analg. 1980 Nov;59(11):815-25
pubmed: 7191670
J Cardiothorac Vasc Anesth. 2019 Feb;33(2):418-425
pubmed: 30293833
Acta Anat (Basel). 1996;156(2):132-42
pubmed: 8993633
Indian J Anaesth. 2019 Jul;63(7):517-519
pubmed: 31391613
Adv Anesth. 2019 Dec;37:187-205
pubmed: 31677656
Anaesthesia. 2020 Oct;75(10):1372-1385
pubmed: 32062870