Journal of Pain Research (Dec 2021)

Serratus Anterior Block for Long-Term Post-Thoracoscopy Pain Management

  • Semyonov M,
  • Fedorina E,
  • Shalman A,
  • Dubilet M,
  • Refaely Y,
  • Ruderman L,
  • Frank D,
  • Gruenbaum BF,
  • Koyfman L,
  • Friger M,
  • Zlotnik A,
  • Klein M,
  • Brotfain E

Journal volume & issue
Vol. Volume 14
pp. 3849 – 3854

Abstract

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Michael Semyonov,1,* Ekaterina Fedorina,1,* Anna Shalman,1 Michael Dubilet,1 Yael Refaely,2 Leonid Ruderman,2 Dmitry Frank,1 Benjamin F Gruenbaum,3 Leonid Koyfman,1 Michael Friger,4 Alexander Zlotnik,1 Moti Klein,1 Evgeni Brotfain1 1Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel; 2Department of Cardiothoracic Surgery, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel; 3Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA; 4Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel*These authors contributed equally to this workCorrespondence: Evgeni BrotfainDepartment of Anesthesiology and Critical Care, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, 84101, IsraelTel +972 54-621-8106Email [email protected]: Neuropathic, chronic pain is a common and severe complication following thoracic surgery, known as post-thoracotomy pain syndrome (PTPS). Here we evaluated the efficacy of an ultrasound-guided serratus anterior plane block (SAPB) on pain control compared to traditional pain management with intravenous opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) six months after thoracic surgery.Patients and Methods: In this retrospective observational study, we analyzed data from a questionnaire survey. We interviewed all patients who underwent elective video-assisted thoracoscopy surgery (VATS) at Soroka University Medical Center between December 2016 and January 2018. The responses of ninety-one patients were included.Results: Participants reported PTPS in both groups, 43% of patients in the SAPB group and 57% of patients in the standard group, which failed to reach significance. However, we demonstrated that the percentage of pain occurrence trended lower in the SAPB group. There was significantly less burning/stitching or shooting, shocking, pressure-like, and aching pain in SAPB patients compared to the standard protocol group. Patients in the SAPB group had significantly less pain located in the upper and lower posterior thorax anatomical regions compared to the standard protocol group. Moreover, we found a significant difference in occurrence of PTPS depending on the type of thoracic surgery. From both study groups, 69% of patients who underwent lobectomy reported pain, compared with 41.9% of those in the segmental (wedge resection) procedure, and 42.1% of patients in other procedures.Conclusion: While the present study did not demonstrate a statistically significant reduction of PTPS after SAPB concerning postoperative pain control, there was a trend of a decrease. We also found significance in the type of pain and location of pain after thoracic surgery between the two groups, as well as a significant difference between pain occurrence in types of thoracic surgeries from both groups.Keywords: chronic pain, post-thoracotomy pain syndrome, PTPS, regional anesthesia block, serratus anterior, thoracic surgery

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