Efficacy of Perioperative US-Guided Serratus Anterior Plane Block Versus Thoracic Epidural in Adult Patient Undergoing Thoracotomy: A Randomized Comparative Double-Blinded Trial

Thoracic surgeries is known to be one of the most painful surgeries and it is considered the major factor to the morbidity and mortality postoperatively. A variety of analgesic techniques for example; systemic opioid, intercostal nerve blockade, intra-pleural analgesia, an epidural opioid with or without local anesthetic, and patient-controlled analgesia (PCA) via systemic or epidural route has been used very commonly for thoracotomy pain management.The use of systemic opioids alone was associated with a 23.4% incidence of post-thoracotomy pain syndrome. Also, high doses of opioids represent a safety concern due to respiratory depression. The high incidence of postoperative nausea and vomiting (PONV) exacerbates patients' discomfort. Long-acting opioids hinder faster recovery, thereby delaying discharge. , Serratus anterior plane block (SAPB) has been recently introduced as a promising method that can be used between T2 and T9 levels for analgesia in thoracic surgery. SAPB seems to provide its effect through blockade of the lateral cutaneous branches of the intercostal nerves. Previous reports showed that after superficial SAPB the duration of sensory block was between 7 and 12 hrs. Continuous SAPB could represent an important analgesic alternative in patients who have contraindications to thoracic epidural for example patients with coagulopathies. Hence it is important to thoroughly study this block as an analgesic modality in thoracotomies. Moreover, episodes of hypotension during thoracotomies as during vascular clamping are challenging in the presence of thoracic epidural.

The purpose of our study is to compare the effectiveness of perioperative continuous serratus anterior plane block versus continuous thoracic epidural in pain management during thoracic surgeries for malignancy resection. To the best of our knowledge controlled randomized, prospective studies about the use of this technique in thoracotomies for resection of malignancies are lacking and none has been published to discuss this issue. Also, studies reporting patients' satisfaction are lacking.

Aim of the work

This study aims at evaluating the efficacy of applying continuous serratus anterior plane block (SAPB)as a perioperative analgesic modality for thoracic cancer surgeries (mesothelioma and bronchogenic carcinoma) as compared to continuous thoracic epidural as reflected on decreasing perioperative opioids consumption and postoperative VAS.

Hypothesis