Analgesic Effect of Erector Spinae Versus Serratus Anterior Plane Block for Thoracoscopic Sympathectomy

Not Applicable

• Conditions: Thoracic Sympathectomy
• Interventions: Procedure: Serratus anterior plane block; Procedure: Erector spinae plane block

• Registration Number: NCT04486014
• Lead Sponsor: Mansoura University

Brief Summary

* Thoracic incisions are painful and associated with chronic post-surgical pain and inadequate analgesia is associated with poorer postoperative outcomes. Recent progress has been made in the field of thoracic anesthesia by improving analgesic modalities such as PECS 1 and PECS 2, intercostal plane block, paravertebral regional anesthesia, ultrasound-guided erector spinae and serratus anterior plane block.

* Administered of the local anesthetic in erector spinae plane block is in the interfascial plane between the transverse process of the vertebra and the erector spinae muscles, spreading to multiple paravertebral spaces. It affects both the ventral and dorsal rami and leading to blockage of both visceral and somatic pain.

* Ultrasound-guided serratus anterior plane block is a facial plane block that provides analgesia by blocking of lateral branches of intercostal nerves above or below the serratus plane muscle.

* We hypothesize that the ultrasound-guided erector spinae plane block may have better quality than the serratus anterior plane block for patients undergoing thoracoscopic sympathectomy as erector spinea plane blocks visceral and somatic pain.

Detailed Description

Primary palmar hyperhidrosis (PPH) refers to the excessive secretion of exocrine glands on the palms, which is often accompanied by the head, face, or plantar hyperhidrosis. PPH demonstrates no obvious organic cause; however, some patients may feel distressed because their palms sweat more than normal, and such a situation may lead to severe psychological, social, and occupational dysfunction.

Endoscopic thoracic sympathectomy abolishes eccrine sweating in all areas supplied by the postganglionic fibers with its complications which include post-sympathetic neuralgia which is the most important, wound infection, hemorrhage, pneumothorax, horner syndrome, no response to the operation and compensatory hyperhidrosis in non-denervated areas.

Forero described ultrasound-guided erector spinae plane block for treatment of thoracic neuropathic pain and explained it as a peri-paravertebral regional anesthesia technique that has been used for prevention of postoperative pain in various surgeries.

Ultrasound-guided serratus anterior plane block is a facial plane block which provides analgesia by blocking of lateral branches of intercostal nerves above or below the serratus plane muscle. There are few cases and studies in the literature reporting successful analgesia provided by serratus anterior plane block

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2020-07-22
• Study First Submitted QC: 2020-07-23
• Study First Posted: 2020-07-24
• Status Verified: 2020-09
• Study Start: 2020-09-14
• Last Update Submitted: 2021-02-05
• Last Update Posted: 2021-02-08
• Primary Completion: 2021-07
• Study Completion: 2022-01

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 110

Inclusion Criteria

• American Society of Anesthesiologists grade I or II physical status

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Exclusion Criteria

• Patients who had coagulopathies
• local infections
• neuropathies
• neuromuscular disease
• psychiatric disease
• history of thoracic surgery
• history of allergy to local anesthetics.
• receiving chronic analgesic therapy
• drug abusers

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Serratus anterior plane block (SAP)	Serratus anterior plane block	Patients would receive serratus anterior plane block
Erector spinae plane block (ESP)	Erector spinae plane block	Patients would receive erector spinae plane block

Primary Outcome Measures

Name	Time	Method
The total analgesic consumption	1st 24 hours after surgery	cumulative consumption of opioids during the first postoperative day

Secondary Outcome Measures

Name	Time	Method
The total amount of fentanyl consumption	1st 24 hours after surgery	cumulative consumption of fentanyl during the first postoperative day
Duration of analgesia	within 24 hours after surgery	from the end of block till the time for the first analgesic requirement (ketorolac)
Nausea	1st 24 hours after surgery	number of patients with nausea
mean blood pressures	Intraoperative (every 10 minutes till the end of surgery)	changes in mean arterial blood pressure
Vomiting	1st 24 hours after surgery	number of patients with vomiting
systolic blood pressure	Intraoperative (every 10 minutes till the end of surgery)	changes in systolic blood pressure
diastolic blood pressures	Intraoperative (every 10 minutes till the end of surgery)	changes in diastolic blood pressure
Postoperative severity of the pain	every 2 hours for 12hours and then at 16, 20 and 24 hours postoperatively	Visual analogue scale (0-100),where 0 point is equal to no pain and 100 indicate the worst possible pain
The total amount of paracetamol consumption	1st 24 hours after surgery	cumulative consumption of paracetamol during the first post operative day
Peripheral oxygen saturation	Intraoperative (every 10 minutes till the end of surgery)	changes in Peripheral oxygen saturation as measured with pulse oximetry
Patient Satisfaction	After 12 and 24 hours after surgery	evaluated as 5:excellent, 4:very good, 3:good, 2: fair, 1:poor
Heart rate	Intraoperative (every 10 minutes till the end of surgery)	changes in heart rate
End-tidal carbon dioxide tension	Intraoperative (every 10 minutes till the end of surgery)	changes in end-tidal carbon dioxide tension as measured with capnography

Trial Locations

Locations (1)

Mansoura University; 🇪🇬 Mansoura, DK, Egypt