US-Guided Serratus Anterior Plane Block Versus Thoracic Epidural in Patients Undergoing Thoracotomy

Summary

Thoracic surgeries is known to be one of the most painful surgeries . Multiple analgesic techniques have been used for post operative analgesia including Thoracic epidural , Patient Controlled Analgesia and systemic opioids. Opioids are associated with multiple sied effects including : PONV , Respiratory depression and ileus while thoracic epidural has its own complications such as hemodynamic instability , injury of spinal cord, pneumothorax and epidural hematoma.

Peripheral nerve blocks provide good alternative for perioperative analgesia. 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.

Conditions

• Lung Cancer
• Acute Pain
• Chronic Pain

Interventions

PROCEDURE

Continuous Serratus anterior plane block

in lateral position a linear transducer (10-12MHz, M-Turbo) will be used, The 5th rib is identified in the mid-axillary line. The following muscles are overlying the rib latissimusdorsi ,teres major, and serratus muscle.The needle (22G, 50-mm Tuohy needle) is introduced in-plane targeting the plane superficial to serratus muscle. local anesthetic is injected then a catheter is threaded and . Ultrasound-guided SAPB was done using a serratus anterior catheter Group DL (n=20) received a bolus of 30 mL of 0.25% bupivacaine followed by a continuous infusion of 0.125% bupivacaine at a rate of 7-12 ml/hr according to patient response upon ICU arrival after the stabilization of the clinical status. The infusion was continued until the end of the 1st 24 hours postoperatively .

PROCEDURE

Thoracic Epidural

A thoracic epidural catheter was done to the patient while sitting. Tuohy needles are used. Epidural space can be identified by loss of resistance. Injection begins with a negative aspiration and a test dose (3 ccs of 1.5% lidocaine with 1:200,000 epinephrine) .A Continuous epidural technique through the placement of a catheter 3-5 cm beyond the needle is applied. Injection in 5ml increments of 0.25% bupivacaine is used until the block of the required segments achieved ( 10 to 15ml). sensory testing is via pinprick and cold test to detect sympathetic block . Throughout the technique hourly injection of 5 ml 0.25% bupivacaine for maintenance.

DRUG

Bupivacaine

bupivacaine

DRUG

lidocaine with epinephrine

3 ccs of 1.5% lidocaine with 1:200,000 epinephrine

Sponsors & Collaborators

• National Cancer Institute, Egypt

  lead OTHER

Principal Investigators

• Ashgan R Ali, Professor · Anaesthesiology Faculty of Medicine - Cairo University

• Heba I Ahmed, Ass. Professor · Anaesthesiology Faculty of Medicine - Cairo University

• Reham M Gamal, Lecturer · Anaesthesiology National Cancer Institute - Cairo University

• Sylvia Samy Bassily Morgan, Master · Anaesthesiology National Cancer Institute - Cairo University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-06-01

Primary Completion

2022-02-01

Completion

2022-03-01

Countries

• Egypt

Study Locations