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Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study
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 absce...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222567/ https://www.ncbi.nlm.nih.gov/pubmed/28115866 http://dx.doi.org/10.2147/JPR.S121441 |
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author | Barbera, Cinzia Milito, Pamela Punturieri, Michele Asti, Emanuele Bonavina, Luigi |
author_facet | Barbera, Cinzia Milito, Pamela Punturieri, Michele Asti, Emanuele Bonavina, Luigi |
author_sort | Barbera, Cinzia |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5222567 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-52225672017-01-23 Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study Barbera, Cinzia Milito, Pamela Punturieri, Michele Asti, Emanuele Bonavina, Luigi J Pain Res Original Research 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. Dove Medical Press 2017-01-04 /pmc/articles/PMC5222567/ /pubmed/28115866 http://dx.doi.org/10.2147/JPR.S121441 Text en © 2017 Barbera et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Barbera, Cinzia Milito, Pamela Punturieri, Michele Asti, Emanuele Bonavina, Luigi Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title | Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title_full | Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title_fullStr | Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title_full_unstemmed | Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title_short | Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
title_sort | serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5222567/ https://www.ncbi.nlm.nih.gov/pubmed/28115866 http://dx.doi.org/10.2147/JPR.S121441 |
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