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The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study.

ABSTRACT: BACKGROUND:Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve. METHODS:We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n?=?25) received conventional general anesthesia and Group S (n?=?25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline. RESULTS:Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9??g vs 1047.7??g, P?

SUBMITTER: Lee J

PROVIDER: S-EPMC6504301 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study.

Lee Jungwon J Kim Saeyoung S

Medicine 20190501 18

<h4>Background</h4>Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve.<h4>Methods</h4>We conducted a prospective study in 50 patients, aged ...[more]

PMID: 31045789

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Project description:BackgroundPostoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies.MethodsA randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events.ResultsNo significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015).ConclusionsIn patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).

Project description:To study causes and implications of intraoperative conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy.We performed an institutional review of patients undergoing lobectomy for known or suspected lung cancer with root cause analysis of every conversion from VATS to open thoracotomy.Between 2004 and 2012, 1227 patients underwent lobectomy. Of these, 517 procedures (42%) were completed via VATS, 87 procedures (7%) were converted to open procedures, and 623 procedures (51%) were performed via planned thoracotomy. Patients undergoing thoracotomy were younger and had a higher incidence of prior lung cancers. Planned thoracotomy and conversion group patients had higher clinical T stage than patients in the VATS group, whereas the planned thoracotomy group had higher pathologic stage than patients in the other groups. Postoperative complications were more frequent in patients in the conversion group (46%) than in the VATS group (23%; P < .001), but similar to the open group (42%; P = .56). Validating a previous classification of causes for conversion, 22 out of 87 conversions (25%) were due to vascular causes, 56 conversions (64%) were for anatomy (eg, adhesions or tumor size), and 8 conversions (9%) were the result of lymph nodes. No specific imaging variables predicted conversion. Within the conversion groups, emergent (20 out of 87; 23%) and planned (67 out of 87; 77%) conversion groups were similar in patient and tumor characteristics and incidence of perioperative morbidity. The conversion rate for VATS lobectomy dropped from 21 out of 74 (28%), to 29 out of 194 (15%), to 37 out of 336 (11%) (P < .001) over 3-year intervals. Over the same periods, the proportion of operations started via VATS increased significantly.With increasing experience, a higher proportion of lobectomy operations can be completed thoracoscopically. VATS should be strongly considered as the initial approach for the majority of patients undergoing lobectomy.

Project description:BACKGROUND:In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa. METHODS:The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed. RESULTS:All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05). CONCLUSIONS:Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.

Dataset Information

The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study.

Publications

The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy: A randomized prospective study.

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