• Francesco Baldinelli, Giuseppe Capozzoli, Roberta Pedrazzoli, Birgit Feil, Marco Pipitone, and Francesco Zaraca.
• 1st Service of Anesthesia and Intensive Care, Central Hospital, Bolzano, Italy. Electronic address: francesco.baldinelli@sabes.it.
• J. Cardiothorac. Vasc. Anesth. 2021 Aug 1; 35 (8): 2297-2302.

ObjectivesVideo-assisted thoracoscopy surgery-lobectomy is less invasive than conventional thoracotomy and is associated with fewer complications. However, the pain related is classified as moderate and requires adequate treatment. Ultrasound-guided serratus anterior plane block (SAPB) provides analgesia by blocking the lateral branches of the intercostal nerves, avoiding the complications of epidural analgesia and paravertebral block. The aim of the present study was to evaluate the efficacy and safety of the SAPB compared with the intercostal nerve block (ICNB).DesignThis was a non-randomized prospective study, in which surgery-lobectomy pain after video-assisted thoracoscopy was treated with the following multimodal approach: SAPB or ICNB, morphine-patient controlled analgesia, and paracetamol.SettingThe study was undertaken in a single community hospital.ParticipantsThe study comprised 40 patients.InterventionsExecution of ultrasound-guided SAPB.Measurements And Main ResultsNineteen (47.5%) men and 21 (52.5%) women were enrolled, and the mean age was 67.22 ± 11 years. Both groups showed any visual analog scale values >4, which was significantly lower in the SAPB group at the 6th hour and at the 12th and 24th hours only during coughing (p < 0.05). The sedation score was significantly lower in the ICNB group at 0 and at the 2nd and 4th hours; it was lower in the SAPB group at the 6th hour. All patients had a sedation score <1, and they all were awake and oriented. After 24 hours, the total morphine requirement was 19.3 ± 14.4 mg and 11.3 ± 8.5 mg (p = 0.038); after 48 hours, it was 12.2 ± 7.9 mg and 8.2 ± 5.8 mg in the ICNB and SAPB groups, respectively.ConclusionsThe multimodal approach of SAPB, morphine-patient controlled analgesia, and paracetamol is effective, safe, and time efficient.Copyright © 2020 Elsevier Inc. All rights reserved.

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