Abstract

Background: Post thoracotomy pain results in acute complications such as pulmonary complications (due to ineffective coughing, which leads to retention of secretion) in the short term and chronic post thoracotomy pain in the long term. The purpose of this study was to evaluate the efficacy and safety of a continuous serratus anterior plane block (SAPB) compared with continuous thoracic epidural analgesia (TEA) in patients undergoing open lung resection.
Methodology: This randomized, open-labeled, parallel-controlled trial was done on 60 patients aged 20 to 60 years with American Society of Anesthesiologists physical status II-III underwent elective thoracotomy for lung cancer surgery. Patients were randomly allocated according to analgesia either via a thoracic epidural catheter (10 ml levobupivacaine 0.25%, followed by 5 ml/hour of 0.125%) or an ultrasound-guided SAPB (30 ml levobupivacaine 0.25% followed by 5 ml/hour of 0.125%).
Results: After excluding five patients, 27 and 28 patients were allocated to the TEA and SAPB groups, respectively. Intraoperatively and until 24 hrs after the end of surgery, the mean arterial pressure and heart rate were higher in the SAPB group than in the TEA group. Intraoperatively, the dose of fentanyl was higher in the SAPB group. Postoperatively, VAS at rest and cough were significantly higher in the SAPB group. The occurrence of nausea and vomiting, hypotension, and bradycardia were similar in the groups.
Conclusions: In patients undergoing open lung resection for cancer, continuous SAPB was less effective than TEA in controlling postoperative pain and presented similar adverse events.

Key words: Serratus plane block, Thoracic epidural, Continuous, Thoracotomy pain, Acute