Postoperative pain and total analgesic use after serratus posterior superior intercostal plane block during video-assisted thoracoscopic surgery

A research that was recently published looked at how Serratus posterior superior intercostal plane block (SPSIPB) affected patients having video-assisted thoracoscopic surgery (VATS) in terms of post-operative pain and total intravenous (IV) tramadol use. The main goal was to compare the numerical rating scale (NRS) ratings in the SPSIPB arm with the control arm after VATS in order to determine the impact of this block on post-operative analgesia. The quantity of tramadol and rescue analgesic (paracetamol) that the patients ingested, as well as their 24-hour post-operative follow-up, were secondary goals.

24 patients, ages 18 and above, with physical status I–III according to the American Society of Anesthesiologists (ASA), received wedge resection or biopsy utilising the uniportal VATS method. The SPSIPB group (n = 12) and the control group (n = 12) were the two randomly assigned groups of patients. Every patient in both groups was put under general anaesthesia, and those in the SPSIPB group had SPSIPB after the surgical closure but before the residual neuromuscular blockade was reversed.

The transducer probe was positioned transversely at the level of the spina scapula, and the patients were put in the lateral decubitus posture for SPSIPB. The 80 mm needle was advanced using the in-plane approach to ensure that no visible needle entered through the skin and subcutaneous tissue to target the third rib from the medial border of the scapula in the caudocranial direction. A test dosage of 1-2 mL saline was used to conduct hydro-dissection between the SPSM and the third rib after negative aspiration and the observation of no blood when the needle tip was inserted between the SPSM and the rib.

The purpose of the research was to examine the post-operative analgesia after VATS surgery in patients with spinal cord injuries (SPSIPB). Ten minutes before to skin closure, patients received 50 mg of dexketoprofen IV and 1 g of paracetamol IV. After that, the patients were put to sleep and neuromuscular reversal and extubation were carried out. The length of the procedure was noted, and the patients' IV tramadol infusion was attached to a PCA pump. As a rescue analgesic, patients who had a numerical rating scale (NRS) score of >4 even with PCA were given 1 g of paracetamol intravenously. According to the research, the SPSIP group consistently had NRS ratings that were far lower than those of the control group.

With the exception of the 0–1st hour, the SPSIP group's tramadol intake was consistently lower than that of the control group. In a 24-hour period, the SPSIP group consumed an average of 58.33 mg of tramadol, whereas the control group consumed 144.17 mg. Neither the SPSIP group nor any of the patients in the group required rescue analgesia during the 24-hour follow-up.

Regarding adverse effects, there were two patients in the control group who suffered from nausea whereas none of the SPSIPB group's patients did. There were no instances of hemodynamic instability or pneumothorax in the SPSIPB or control groups.

According to the research, after video-assisted thoracoscopic surgery (VATS), Serratus posterior superior intercostal plane block (SPSIPB) may effectively relieve thoracic pain. The research discovered no appreciable variation in tramadol intake after post-operative SPSIPB and no need for rescue analgesics during the first 18 hours following surgery. The SPSIP group used far less paracetamol than the control group; in the final six hours, the control group's dynamic NRS scores only dropped to around 4.

Nevertheless, the study has certain drawbacks, including a limited patient population and a dearth of research on sensory dermatomes. Additionally, if the patients had received varying amounts of local anaesthetic for comparison, the volume-dependent fluctuation of the SPSIPB's analgesic effectiveness may have been made clear.

For post-operative analgesia after VATS procedures, paravertebral block (PVB) and erector spinae plane (ESP) block are often used. Because single-shot serratus anterior plane (SAP) blocks are simpler to apply and have a lower rate of problems, the current PROSPECT guideline suggests them as a backup choice. Due to its positioning, which avoids the danger of pneumothorax and targets the third rib, SPSIPB is regarded as a safe method. To get more conclusive results, nevertheless, further randomised clinical studies and comparisons with other blocks are required.

Reference –

Avci, Onur; Gundogdu, Oğuz; Balci, Fatih; Tekcan, Muhammed N.; Ozbey, Mahmut1. Efficacy of serratus posterior superior intercostal plane block (SPSIPB) on post-operative pain and total analgesic consumption in patients undergoing video-assisted thoracoscopic surgery (VATS): A double-blinded randomised controlled trial. Indian Journal of Anaesthesia 67(12):p 1116-1122, December 2023. | DOI: 10.4103/ija.ija_589_23