GÖZEN ÖKSÜZ, Muhammed SAYAN, MAHMUT ARSLAN, AYKUT URFALIOĞLU, HAFİZE ÖKSÜZ, BORA BİLAL, OYA YALÇIN ÇOK

THE COMPARISON OF SERRATUS ANTERIOR PLANE BLOCK VERSUS INTERCOSTAL BLOCK FOR POSTOPERATIVE ANALGESIA FOLLOWING THORACOTOMY SURGERY

Objective: Pain after thoracotomy is one of the most severe pain experienced by the patients. Intercostal nerve block (IB) is one of the most commonly used methods of pain management after thoracotomy operations. Serratus anterior plane block (SAPB) is a novel block that has been shown to be effective for pain management in thoracic surgery. In this study, we aimed to compare the postoperative visual pain scores (VAS) and analgesic consumption following serratus anterior plane block or intercostal nevre block in patients undergoing thoracic surgery. Method: Patients who underwent thoracotomy operation in our clinic between May 2016 and May 2017 were reviewed retrospectively. Demographic data, postoperative analgesic consumptions and complications were evaluated. Results: Data of 42 patients undergoing thoracotomy operation were obtained. Twenty two patients were performed with IB and 20 patients were performed with SAPB. When the two groups were compared, age, gender, weight, height, duration of operation were similar. VAS scores at postoperative 1 st , 2 nd , 4 th , 6 th , 12 th and 24t h hours were found to be significantly lower in the SAPB group (p

TORAKOTOM‹ OPERASYONLARINDA POSTOPERAT‹F ANALJEZ‹ ‹Ç‹N YAPILAN SERRATUS ANTER‹OR PLAN BLO⁄UNUN ‹NTERKOSTAL BLOK ‹LE KARfiILAfiTIRILMASI

Amaç: Torakotomi sonras› a¤r›, hastalar›n yaflad›¤› en fliddetli a¤r›lardan biridir. ‹nterkostal sinir blo¤u (IB) torakotomi operasyonlar› sonras› görülen a¤r› yönetiminde en s›k kullan›lan yöntemlerden biridir. Serratus anterior plan blo¤u (SAPB) yeni tan›mlanan ve toraks cerrahisinde etkinli¤i gösterilmifl bir gövde blo¤udur. Bu çal›flmada klini¤imizde toraks cerrahisi yap›lm›fl hastalara uygulanan interkostal sinir blo¤u (‹B) ile SAPB’›n postoperatif vizüel a¤r› skorlar›n› (VAS) ve analjezik tüketimini karfl›laflt›rmay› amaçlad›k. Yöntem: 2016 May›s – 2017 May›s aras›nda klini¤imizde torakotomi operasyonu olmufl hastalar retrospektif olarak incelendi. Hastalar›n demografik verileri, postoperatif kullan›lan analjezik miktar›, postoperatif VAS skorlar› ve komplikasyonlar kay›tlardan incelendi. Bulgular: Torakotomi operasyonu yap›lm›fl 42 hastan›n verilerine ulafl›ld›. Yirmi iki hastaya IB ve 20 hastaya SAPB uyguland›¤› görüldü. Her iki grup karfl›laflt›r›ld›¤›nda yafl, cinsiyet, kilo, boy, operasyon süresi benzer bulundu. Postoperatif 24 saatlik analjezik kullan›m›n›n ve postoperatif 1., 2., 4., 6., 12., 24. saatte VAS skorlar›n›n SAPB grubunda anlaml› olarak az oldu¤u görüldü. (p

PDF

___

De Cosmo G, Aceto P, Gualtieri E, Congedo E. Analgesia in thoracic surgery: review. Minerva Anestesiol 2009; 75: 393-400.

Pluijms WA, Steegers MAH, Verhagen AF, Scheffer GJ, Wilder- Smith OH. Chronic post-thoracotomy pain: A retrospective study. Acta Anaesthesiol Scand 2006; 50: 804-808.

Cok OY, Eker HE, Turkoz A, et al. Thoracic epidural anesthesia and analgesia during the perioperative period of thoracic surgery: Levobupivacaine versus bupivacaine. J. Cardiothorac Vasc Anesth 2011; 25: 449-454.

Feddy L, Rozario C. Analgesia for thoracotomy. Anaesth. Intensive Care Med 2011; 12: 563-564.

Moore DC. Anatomy of the intercostal nerve: Its importance during thoracic surgery. Am J Surg 1982; 144: 371-373.

Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: A novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68: 1107-1113.

Luketich JD, Land SR, Sullivan EA, , et al. Thoracic epidural versus intercostal nerve catheter plus patient-controlled analgesia: A randomized study. Ann Thorac Surg 2005; 79: 1845-1850.

Rice DC, Cata JP, Mena GE, Rodriguez-Restrepo A, Correa AM, Mehran RJ. Posterior Intercostal Nerve Block With Liposomal Bupivacaine: An Alternative to Thoracic Epidural Analgesia. Ann Thorac Surg 2015; 99: 1953-1960.

Madabushi R, Tewari S, Gautam SK, Agarwal A, Agarwal A. Serratus anterior plane block: a new analgesic technique for post-thoracotomy pain. Pain Physician 2015; 20: E421-E424.

Ökmen K, Ökmen BM. The efficacy of serratus anterior plane block in analgesia for thoracotomy: a retrospective study. J Anesth 2017; 31: 579-585.

Corso RM, Piraccini E, Byrne H, Poggi P, Tedesco M. The serratus anterior plane block for pediatric non-intubated video-assisted thoracoscopic surgery. Minerva Anestesiol 2017; 83: 775-776.

Okmen K, Okmen BM, Uysal S. Serratus anterior plane (SAP) block used for thoracotomy analgesia: A case report. Korean J Pain 2016; 29: 189-192.

Durant E, Dixon B, Luftig J, Mantuani D, Herring A. Ultrasound- guided serratus plane block for ED rib fracture pain control. Am J Emerg Med 2017; 35: 197.

Barbera C, Milito P, Punturieri M, Asti E, Bonavina L. Serratus anterior plane block for hybrid transthoracic esophagectomy: A pilot study. J Pain Res 2017; 10: 73-77.

Khalil AE, Abdallah NM, Bashandy GM, Kaddah TA. Ultrasound- Guided Serratus Anterior Plane Block Versus Thoracic Epidural Analgesia for Thoracotomy Pain J Cardiothorac Vasc Anesth 2017; 31: 152-158.

Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth 2017; 61: 381-386.

Pérez Herrero MA, López Álvarez S, Fadrique Fuentes A, Manzano Lorefice F, Bartolomé Bartolomé C, González de Zárate J. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim 2016; 63: 564-571.

Piracha MM, Thorp SL, Puttanniah V, Gulati A. "A Tale of Two Planes": Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome. Reg Anesth Pain Med 2017; 42: 259-262.