Novel Use of Serratus Anterior Plane Block for Post-Thoracotomy Pain

A brief commentary in the journal Pain Physician presented an interesting treatment option for pain following thoracotomy. Management of post-thoracotomy pain is a steep challenge, not least of which because pain following thoracotomy can be severe and because such pain can affect respiratory mechanics and, if unchecked, can lead to development of chronic pain syndrome.

The commentary was provided by practitioners at the Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, in Lucknow, India. The case study looked at a 21-year-old male patient who underwent esophagectomy and esophago-gastric anastomosis for corrosive stricture of the esophagus. During weaning from ventilation and sedation, the patient indicated severe pain in the thoracotomy incision. The pain was severe enough to impair tidal breathing. The practitioners evaluated the efficacy of the serratus anterior plane (SPB) block in the management of thoracotomy pain.

SPB is a relatively new—and comparatively simple—technique that is gaining popularity in the management of pain from rib fractures and breast surgeries. SPB is also an alternative to current regional anesthetic techniques such as thoracic paravertebral and central neuraxial blockade for achieving paresthesia of the hemithorax.

Analgesic options for thoracotomy include thoracic epidural paravertebral block, interpleural block, and intrathecal opioids, all of which are invasive techniques that demand normal coagulation patterns. In this case, the patient had “deranged coagulation parameters due to sepsis.” The SAP block was done under ultrasound guidance in the mid-axillary line at the level of the fourth rib and the catheter was placed superficial to the serratus plane. The patient expressed relief in pain within 10 minutes of being given the bolus of local anesthetic.

SPB is currently the subject of a number of clinical trials, including one in South Korea that is expected to be completed in November 2015. This case study will likely garner additional interest in using SPB beyond anesthesia of the hemithorax.