Akademik Veri Yönetim Sistemi
Asian Society of Pediatric Anesthetists Congress 2023 (ASPA2023), Seoul, Güney Kore, 16 - 18 Haziran 2023
Comparison of ultrasound guided thoracic paravertebral block versus serratus anterior plane block in children undergoing thoracic surgery: A randomized controlled study
Elif Kasap1, Emre Sertaç Bingül1, Emre Şentürk2, Ebru Emre Demirel1, Zerrin Sungur1, Suna Arat1, Meltem Savran Karadeniz1
1 Department of Anesthesiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
2 Department of Anesthesiology, Beylikduzu State Hospital, Istanbul, Turkey
Background: Thoracic paravertebral block (TPVB) and serratus anterior plane block (SAPB) are two truncal blocks that are alternative to thoracic epidural block in thoracic surgery. In the current study, it is aimed to compare the effects of ultrasound (US) guided TPVB and US guided SAPB on postoperative pain and opioid consumption in pediatric thoracic surgery population.
Methods: After obtaining ethics committee approval, 46 children whose legal guardians provided consent (1-14 years old) and were scheduled for lung resection were included in the study. TPVB (Group T) and SAPB (Group S) were performed prior to incision with 0.5 ml/kg or 0.4 ml/kg bupivacaine, respectively. The primary outcome was total intravenous (IV) morphine consumption in postoperative 48 hours. Secondarily, FLACC scores were evaluated at postoperative 0th, 15th, 30th, 45th minutes and at 1st, 2nd, 6th, 24th, and 48th hours. If the FLACC score was >4, 0.03 mg/kg morphine IV was administered as rescue analgesia. Other types of analgesics were not provided since a strong opioid was chosen along with truncal block. Time to first morphine administration (minutes), time to first mobilization (minutes), lentgh of hospital stay (hours), postoperative vomiting (POV) incidence (%), and chronic pain incidence (%) were also recorded. Chronic pain was evaluated three months after the surgery.
Results: Total 40 patients were included. Demographic data, ASA physical status scores and duration of surgery were similar in both groups (p>0,05). Morphine consumption during postoperative 48 hours was higher in Group S (0.24±0.07 mg/kg) than in Group T (0.17±0,08 mg/kg) (p=0,01). Time to first morphine administration was shorter in Group S comparing to Group T (205,5±68,7 min vs 356,7±83 min, respectively, p<0,001). Both groups did not differ with regards to intraoperative fentanyl consumption, time to first mobilization, length of hospital stay, POV incidence, and chronic pain incidence (p>0.05). (Table 1). During the postoperative two hours, FLACC scores were statistically close between two groups (p>0.05). However, in Group S, postoperative 6th, 12th, and 24th hours FLACC scores were significantly higher. (p=0.01 p=0.02 p<0.001) (Table 2).
Conclusion: This study demonstrated that both US-guided SAPB and US- guided TPVB provided effective postoperative analgesia in early postoperative hours in pediatric patients undergoing thoracic surgery. However, after postoperative 6th hour, TPVB was superior to SAPB in terms of FLACC scores, postoperative morphine consumption and time to first analgesic requirement.