457 posters, 2 videos, 2 audios, 8 topics, 45 sessions, 401 authors, 265 institutions

49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

March 21-23, 2024 | The Hilton Bayfront San Diego | San Diego, California

5299

RELATIVE PERIOPERATIVE ANALGESIC EFFICACY OF SERRATUS ANTERIOR PLANE BLOCK VS PARAVERTEBRAL BLOCK IN BREAST AND THORACIC SURGERY-

Preview of RELATIVE PERIOPERATIVE ANALGESIC EFFICACY OF SERRATUS ANTERIOR PLANE BLOCK VS PARAVERTEBRAL BLOCK IN BREAST AND THORACIC SURGERY-

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Poster Presenter

Jeetinder makkar

Authors

Jeetinder makkar

Affiliations

Post Graduate Institute of Medical Education and research

Part of Topic

Scientific Abstracts > Regional Anesthesia

•Thoracic paravertebral (TPV) block -first choice for both major oncological breast and thoracic surgery

•Technically challenging block, higher potential for complications -researchers looking for a safer alternative

•Serratus anterior plane (SAP) block- simple, safe, and effective alternative, that blocks intercostal nerves, long thoracic nerve, and thoracodorsal nerve

•Various retrospective and prospective trials conducted to compare these blocks for breast and thoracic surgery, however, there is a lack of aggregate meta-analysis

OBJECTIVE

To accumulate evidence from published randomized controlled trials (RCTs) on the relative analgesic efficacy of SAP and TPVblock for breast and thoracic surgery

METHODS

•Trials with analgesia outcomes SAP block compared with TPV block in patients undergoing breast and thoracic surgery.

• Adults ≥18 years

•Patients receiving single-shot SAP block, either superficial or deep approach

•Patients receiving TPV block. The trial excluded if a combination of block or catheter technique was utilized

•Primary Outcome: Time to the first rescue analgesia in the postoperative period.

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•Secondary outcomes: opioid consumption in the 24 h, area under the curve (AUC) for static pain scores in 24 hours, pain scores (static and dynamic) at early (4-6 hours) and late (24 h) intervals, opioid-related side effects, patient satisfaction, adverse events.

Search strategy

•Two independent reviewers - comprehensive literature search in PubMed, EMBASE, and SCOPUS, till January 2022.

•Search terminology included terms covering the topics ‘serratus anterior plane block AND paravertebral block AND breast OR thoracic surgery’.

Results

141 patients enrolled across 18 RCTs. 587 underwent SAP block, and 554 underwent TPV block. 13 trials with low RoB, and 5 were having high RoB.

Time to first rescue analgesia (Fig. 1 a)

No significant difference in the time to rescue analgesia with an MD of 0.69 hours (95% CI −1.83 to 0.45; p=0.24; I2 =98%) (Moderate certainty). Thoracic surgery subgroup: TPV block associated with a statistically significant prolongation of time to first rescue analgesia MD of 0.60 hours (95% CI −0.99 to -0.21; p=0.003; I2 =0%)

Cumulative 24-hour oral morphine equivalent consumption (Fig. 1 b)

No significant difference between the two groups MD of 7.18 mg (95% CI −0.23 to 14.60; p=0.06; I2=98%) (low certainty). Thoracic surgery subgroup showed a statistically significant difference in the TPV block group with MD of 9.73 mg (95% CI 0.26 to 19.20; p=0.004; I2 =97%)

AUC for pain scores at rest in 24 hours (Fig. 2)

MD in AUC for resting pain scores showed that TPV was better by 1.39 cm.hr (p=0.14) for breast and by 3.61 cm.hr (p=0.03) for thoracic procedures.

No difference in PONV, only consistently reported opioid-related adverse effects.

Five cases of hematoma and 6 patients reported pain at the puncture site in the TPV arm, and no block-related complications were encountered in the SAP group.

Conclusion

The current evidence suggests that both blocks have comparable analgesic efficacy in the breast surgery population, whereas paravertebral block is associated with marginally better analgesia outcomes after thoracic surgery. Clinicians should weigh these benefits of the TPV block with complication rate and their expertise in deciding the analgesic technique.