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J Cardiothorac Vasc Anesth. 2019 Feb;33(2):418-425. doi: 10.1053/j.jvca.2018.08.209. Epub 2018 Aug 31.

Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the Management of Postoperative Thoracotomy Pain After Pediatric Cardiac Surgery.

Author information

1
Department of Cardiac Anesthesiology, Cardio and Neurosciences Center, AIIMS, New Delhi, India. Electronic address: brajeshkaushal3@gmail.com.
2
Department of Cardiac Anesthesiology, Cardio and Neurosciences Center, AIIMS, New Delhi, India.
3
Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.
4
Department of Cardiothoracic and Vascular Surgery, Cardio and Neurosciences Center, AIIMS, New Delhi, India.
5
Department of Biostatistics, AIIMS, New Delhi, India.

Abstract

OBJECTIVE:

The aim of this study was to compare the relative efficacy of ultrasound-guided serratus anterior plane block (SAPB), pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for the management of post-thoracotomy pain in pediatric cardiac surgery.

DESIGN:

A prospective, randomized, single-blind, comparative study.

SETTING:

Single-institution tertiary referral cardiac center.

PARTICIPANTS:

The study comprised 108 children with congenital heart disease requiring surgery through a thoracotomy.

INTERVENTIONS:

Children were allocated randomly to 1 of the 3 groups: SAPB, Pecs II, or ICNB. All participants received 3 mg/kg of 0.2% ropivacaine for ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal and fentanyl was used for rescue analgesia.

MEASUREMENTS AND MAIN RESULTS:

A modified objective pain score (MOPS) was evaluated at 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. The early mean MOPS at 1, 2, and 4 hours was similar in the 3 groups. The late mean MOPS was significantly lower in the SAPB group compared with that of the ICNB group (p < 0.001). The Pecs II group also had a lower MOPS compared with the ICNB group at 6, 8, and 10 hours (p < 0.001), but the MOPS was comparable at hour 12 (p = 0.301). The requirement for rescue fentanyl was significantly higher in ICNB group in contrast to the SAPB and Pecs II groups.

CONCLUSION:

SAPB and Pecs II fascial plane blocks are equally efficacious in post-thoracotomy pain management compared with ICNB, but they have the additional benefit of being longer lasting and are as easily performed as the traditional ICNB.

KEYWORDS:

intercostal nerve block; pectoral nerves II block; postoperative pain; serratus anterior plane block; thoracotomy; ultrasound-guided

Comment in

PMID:
30293833
DOI:
10.1053/j.jvca.2018.08.209
[Indexed for MEDLINE]

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