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J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

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

Eun Seok Ka , M.D.1, Gong Min Rim , M.D.2, Seungyoun Kang , M.D.2, Saemi Bae , M.D.2, Il-Tae Jang , M.D.2, Hyung Joo Park , Ph.D., M.D.2

1Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea; 2Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea

Correspondence to:Hyung Joo Park
Tel 82-2-1688-9797
Fax 82-2-594-8644
E-mail hyjpark@catholic.ac.kr
ORCID
https://orcid.org/0000-0003-0886-0817

Received: October 6, 2023; Revised: January 3, 2024; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pectus excavatum, Serratus anterior plane block, Postoperative pain, Cryoanlgesia, Minimally invasive repair of pectus excavatum

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ahead

J Chest Surg

Published online March 13, 2024

Copyright © Journal of Chest Surgery.

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

Eun Seok Ka , M.D.1, Gong Min Rim , M.D.2, Seungyoun Kang , M.D.2, Saemi Bae , M.D.2, Il-Tae Jang , M.D.2, Hyung Joo Park , Ph.D., M.D.2

1Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea; 2Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital, Seoul, Korea

Correspondence to:Hyung Joo Park
Tel 82-2-1688-9797
Fax 82-2-594-8644
E-mail hyjpark@catholic.ac.kr
ORCID
https://orcid.org/0000-0003-0886-0817

Received: October 6, 2023; Revised: January 3, 2024; Accepted: January 15, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Pectus excavatum, Serratus anterior plane block, Postoperative pain, Cryoanlgesia, Minimally invasive repair of pectus excavatum

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