Evaluating the effect of ultrasound-guided superficial serratus plane block, deep serratus plane block and thoracic epidural analgesia in cancer patients undergoing thoracotomy: A randomized controlled trial

Background & objective: The serratus anterior plane block (SAPB) is a recent technique providing effective perioperative analgesia in thoracic surgeries. This study compared the intra-operative hemodynamics and the perioperative analgesic efficacy of superficial SAPB, to deep SAPB, and to thoracic epidural analgesia in thoracotomies. Methodology: one hundred and eighty lung cancer patients scheduled for thoracotomy were randomly allocated to three groups; TEA group, which received thoracic epidural analgesia, SSPB group receiving ultrasound-guided superficial serratus plane block and DSPB group which received US-guided deep serratus plane block. Baseline and intra-operative hemodynamics and total consumption of intraoperative fentanyl and postoperative morphine was noted. Results: Intra-operative mean arterial pressure (MAP) significantly decreased in the TEA group compared to baseline values, whereas no significant changes were found in either SSPB or DSPB groups. Heart rate (HR) did not show significant changes in any group. The time to postoperative analgesic demand was significantly longer in the SSPB and DSPB groups than in the TEA group (p < 0.001). In the first postoperative hour, TEA group had significantly higher visual analogue scale (VAS) scores than SSPB or DSPB groups at rest and with cough. The total consumption of intraoperative fentanyl and postoperative morphine was comparable among all groups. Conclusion: Pre-operative SSPB and DSPB can provide adequate perioperative analgesia without hemodynamic instability when compared to TEA in thoracotomies.