Abstract

Background and objectives: The serratus anterior plane block is a regional anesthetic technique performed under ultrasound guidance that can provide analgesia to the thoracic wall as an alternative to the thoracic epidural. We hypothesize that the use of the Serratus Anterior Plane Block (SAPB) would provide non-inferior pain control with fewer episodes of hypotension requiring pharmacologic management, when compared with thoracic epidural analgesia.
Methods: The study population includes patients, who were above the age of 18, were ASA 2-3, who underwent thoracotomy surgeries between 7/1/2014 to 7/1/2017. The primary outcomes being measured are notable episodes of hypotension, requiring pharmacologic vasopressor management, adjustments in the epidural block doses, and the need to discontinue the epidural. Serial trends in MAP, HR, and BP were collected and presented for the entire cohort in the first 24 hours. Secondary outcomes were measured as total morphine equivalents as well as median pain scores during the first 24 hours.
Result: At our institution, a retrospective chart review of serratus plane nerve blocks revealed a total of five performed in the setting of a thoracotomy. When compared to thoracic epidurals, notable episodes of hypotension, morphine equivalents, and the visual analog scale were measured compared to the SAPB.
Conclusion: The SAPB appear to be a safe alternative method to treating postoperative acute thoracotomy pain in the presence of any contraindications to thoracic epidural analgesia.

Keywords: Thoracic epidural; Analgesia; Hypotension; Serratus anterior plane block (SAPB)