Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Serratus Anterior Plane Block: A Better Modality of Pain Control after Pectus Excavatum Repair

  • Eun Seok Ka (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Gong Min Rim (Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital) ;
  • Seungyoun Kang (Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital) ;
  • Saemi Bae (Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital) ;
  • Il-Tae Jang (Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital) ;
  • Hyung Joo Park (Department of Thoracic and Cardiovascular Surgery, Gangnam Nanoori Hospital)
  • Received : 2023.10.06
  • Accepted : 2024.01.15
  • Published : 2024.05.05
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Abstract

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

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References

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