Background: Pain is a major limiting factor in patient’s recovery from major thoracic surgical procedures. Thoracic epidural analgesia (TEA), the current gold standard of perioperative management, has contraindications, can technically fail, and carries a risk of complications such as epidural abscess and spinal hematoma. The ultrasound-guided serratus anterior plane (SAP) block is a promising regional analgesia technique. Objectives: Since the anatomic space involved in the SAP block corresponds to the area exposed by the surgeon during right posterolateral thoracotomy, we investigated the feasibility of a “surgically guided” continuous SAP block as an alternative to TEA in selected esophagectomy patients. Study design: This was a pilot case-series study. Setting: This study was carried out in a tertiary-care university hospital. Methods: The demographic and clinical data of patients in whom the continuous SAP block was performed were retrieved from a prospectively maintained database of hybrid (laparoscopy plus right thoracotomy) Ivor Lewis esophagectomy. The SAP block was performed upon closure of the thoracotomy incision using a 19-gauge catheter tunnelized subcutaneously and positioned in the deep plane between the serratus anterior muscle and the ribs. A bolus dose of 30 mL of levobupivacaine 0.25% was injected, followed by a continuous infusion of the 0.125% solution at 7 mL/h until postoperative day 4. Results: Between January 2016 and July 2016, seven (20%) out of 37 esophagectomy patients underwent a SAP block rather than TEA for the following reasons: inability to insert the epidural catheter, antiaggregation or anticoagulant therapy, or unplanned thoracotomy. The procedure was uneventful in all patients. Only two patients required rescue analgesia on day 1. Conclusion: Continuous SAP block under direct vision is feasible and safe. This novel “surgically guided” application of the SAP block may be useful in case of failure or contraindications to TEA.

Serratus anterior plane block for hybrid transthoracic esophagectomy : a pilot study / C. Barbera, P. Milito, M. Punturieri, E. Asti, L. Bonavina. - In: JOURNAL OF PAIN RESEARCH. - ISSN 1178-7090. - 10(2017), pp. 73-77. [10.2147/JPR.S121441]

Serratus anterior plane block for hybrid transthoracic esophagectomy : a pilot study

P. Milito;E. Asti;L. Bonavina
2017

Abstract

Background: Pain is a major limiting factor in patient’s recovery from major thoracic surgical procedures. Thoracic epidural analgesia (TEA), the current gold standard of perioperative management, has contraindications, can technically fail, and carries a risk of complications such as epidural abscess and spinal hematoma. The ultrasound-guided serratus anterior plane (SAP) block is a promising regional analgesia technique. Objectives: Since the anatomic space involved in the SAP block corresponds to the area exposed by the surgeon during right posterolateral thoracotomy, we investigated the feasibility of a “surgically guided” continuous SAP block as an alternative to TEA in selected esophagectomy patients. Study design: This was a pilot case-series study. Setting: This study was carried out in a tertiary-care university hospital. Methods: The demographic and clinical data of patients in whom the continuous SAP block was performed were retrieved from a prospectively maintained database of hybrid (laparoscopy plus right thoracotomy) Ivor Lewis esophagectomy. The SAP block was performed upon closure of the thoracotomy incision using a 19-gauge catheter tunnelized subcutaneously and positioned in the deep plane between the serratus anterior muscle and the ribs. A bolus dose of 30 mL of levobupivacaine 0.25% was injected, followed by a continuous infusion of the 0.125% solution at 7 mL/h until postoperative day 4. Results: Between January 2016 and July 2016, seven (20%) out of 37 esophagectomy patients underwent a SAP block rather than TEA for the following reasons: inability to insert the epidural catheter, antiaggregation or anticoagulant therapy, or unplanned thoracotomy. The procedure was uneventful in all patients. Only two patients required rescue analgesia on day 1. Conclusion: Continuous SAP block under direct vision is feasible and safe. This novel “surgically guided” application of the SAP block may be useful in case of failure or contraindications to TEA.
Esophageal carcinoma; Post-thoracotomy pain; Serratus anterior block; Thoracic epidural anesthesia; Transthoracic esophagectomy
Settore MED/18 - Chirurgia Generale
Article (author)
File in questo prodotto:
File Dimensione Formato  
JPR-121441-serratus-anterior-plane-block-for-hybrid-transthoracic-esoph_010417.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 965.26 kB
Formato Adobe PDF
965.26 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/814186
Citazioni
  • ???jsp.display-item.citation.pmc??? 11
  • Scopus 24
  • ???jsp.display-item.citation.isi??? 25
social impact