Pectoralis and Serratus Nerves Block in Thoracic Surgery

Soroka University Medical Center168 enrolled

Overview

A new conceptual regional anesthesia the PECs II block (modified pectoral and serratus nerves block) has been described for pain control after thoracic surgery, one of the indications to perform this method is analgesia for surgeries or procedures involving lateral chest wall

The PECs I block was found to be very effective after breast cancer surgery and sub-pectoral prosthesis for pain control management. This block is provided by injection into another myofascial plane, this time between pectoralis minor and serratus anterior muscle at the level of 3rd and 4th rib.PECs II block is simple in performance with a high success rate and minimal incidence of complications, especially, if used ultrasound approach that gives a good understanding of anatomy of the lateral thoracic wall. In present clinical trial we are going to compare PECs block for pain control with traditional pain management techniques based on IV opioids and NSAIDs treatment in patient undergoing thoracic surgery in early postoperative period.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

168

Conditions

Anesthesia Surgery Block Thoracic Injury

Interventions

Bupivacaine HydrochlorideDRUG

40 cc 0.25% of Bupivacaine Hydrochloride injection using ultrasound approach will be administered between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib

UltrasoundDEVICE

All blocks will be done under ultrasound

ThoracotomyPROCEDURE

The patient population will include patients that undergo either open thoracotomy or thoracoscopy for anatomic and non-anatomic lung resection. The standard thoracoscopy approach in our institute includes three holes technic. There are two incisions of 1 cm and utility incision of 4 cm. The standard thoracotomy is posterior- lateral thoracotomy which divided the latissimus dorsi muscle but spears the serratus anterior muscle.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. All patients undergoing thoracic surgery, older ≥18 years 2. Patients who meet criteria of ASA I-II-III class. Exclusion Criteria: 1. Patients who will be unconscious or mentally incompetent 2. Patients refusal to participate in the study 3. ASA -IV -V 4. Patient with coagulopathy 5. Hemodynamically unstable (systolic BP \< 90, HR \> 100) 6. Allergy to local anesthetic drugs or opioids 7. Pregnant patient 8. History of opioid abuse

Outcomes

Primary Outcomes

Comparison Visual Analog Score between groups

First VAS after admission in PACU

Time frame: First 24 hours from the surgery

Secondary Outcomes

Total NSAIDs dosage (mg) in the PACU and department

While the patient is in PACU

Time frame: First 24 hours from the surgery

Length of hospital stay

Measuring time of at discharge from hospital

Time frame: up to 21 days

Total morphine dosage (mg) in the PACU and department

While the patient is in PACU

Time frame: First 24 hours from the surgery

Data from ClinicalTrials.gov

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