Comparitive research between ultrasound guided thoracic para vertebral block, serratus anterior plane block and thoracic erector spinae plane block for post-operative pain relief after thoracotomy

Abstract

Background: Many analgesic modalities have been suggested for management of thoracotomy pain such as peripheral nerve blocks. The purpose of this work was to compare between the post-operative analgesic effect of thoracic paravertebral block (PVB), serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in cases undergoing thoracotomy.Methods: This prospective randomized research was done on 75 adult cases aged 21-60 years scheduled for thoracotomy. Cases were categorized into three equal groups regarding the block had before general anesthesia; PVB group: had ultrasound guided thoracic PVB. SAPB group: had ultrasound guided SAPB. ESPB group: had ultrasound guided ESPB. All cases were monitored for heart rate, mean arterial pressure and pulse oximetry. The following parameters were recorded: postoperative visual analogue score (VAS), quantity of postoperative morphine used after the first dose of emergency analgesic, serum cortisol level and postoperative complications.Results: A significant rise in VAS in group II versus I and III with insignificant difference between I and III. While first time of rescue analgesia was longer in I and III than II with insignificant difference in postoperative complications observed throughout the postoperative period.Conclusions: In cases planned for thoracotomy, the ultrasound-guided technique of performing TPVB and ESPB provide effective intraoperative and prolonged postoperative analgesia versus SAPB as observed by stable hemodynamics and delayed first time of rescue analgesia. Results showed less postoperative morphine dose with superiority toward ESPB regarding simplicity and shorter duration, so it is an effective and safe alternative to TPVB.