Skip to main content
Erschienen in: Aesthetic Plastic Surgery 4/2022

02.08.2022 | Original Article

Ultrasound-guided Bilateral Serratus Anterior Plane Block for Postoperative Analgesia in Ear Reconstruction after Costal Cartilage Harvest: A Randomized Controlled Trial

verfasst von: Chunmei Chen, Guihua Xiang, Keyu Chen, Quanle Liu, Xiaoming Deng, Hang Zhang, Dong Yang, Fuxia Yan

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Costal cartilages harvest for ear reconstruction is accompanied by severe pain in chest. However, there is no perfect solution for reducing this chest pain.

Objective

Evaluate the efficacy and safety of analgesia using ultrasound-guided bilateral serratus anterior plane block (SAPB) in children receiving costal cartilage harvest for ear reconstruction.

Methods

Sixty children undergoing ear reconstruction using costal cartilage were randomized to an SAPB group (SAPB with 3 mg/kg 0.25% ropivacaine) or an incision infiltration (II) group (II with 3 mg/kg 0.75% ropivacaine), and 29 in each group completed the study. All children received patient-controlled intravenous analgesia (PCIA). The primary outcomes were numerical rating scale (NRS) scores of pain while rest and coughing at 1, 6, 12, 24, and 48 h after surgery. The secondary outcomes were sufentanil use within 24 h, duration of analgesia, use of oral rescue analgesics, first time out of bed, and incidence of treatment-related adverse effects.

Results

The SAPB group had lower rest and coughing NRS scores at 6 and 12 h after surgery (all P < 0.001), but the scores were similar at other times. The SAPB group used less sufentanil within 24 h, but had a longer duration of analgesia (both P < 0.001). The II group used more oral rescue analgesics within 48 h, had a longer time until first time out of bed, and had more opioid-related side effects (all P < 0.01). There were no SAPB-related complications.

Conclusion

Ultrasound-guided SAPB can provide safe and effective regional pain relief after costal cartilage harvest for ear reconstruction.

Level of Evidence II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://​www.​springer.​com/​00266.
Literatur
1.
Zurück zum Zitat Luquetti DV, Leoncini E, Mastroiacovo P (2011) Microtia-anotia: a global review of prevalence rates. Birth Defects Res A Clin Mol Teratol 91(9):813–822CrossRef Luquetti DV, Leoncini E, Mastroiacovo P (2011) Microtia-anotia: a global review of prevalence rates. Birth Defects Res A Clin Mol Teratol 91(9):813–822CrossRef
2.
Zurück zum Zitat Deng K, Dai L, Yi L, Deng CF, Li XH, Zhu J (2016) Epidemiologic characteristics and time trend in the prevalence of anotia and microtia in China. Birth Defects Res A Clin Mol Teratol 106(2):88–94CrossRef Deng K, Dai L, Yi L, Deng CF, Li XH, Zhu J (2016) Epidemiologic characteristics and time trend in the prevalence of anotia and microtia in China. Birth Defects Res A Clin Mol Teratol 106(2):88–94CrossRef
3.
Zurück zum Zitat Shaffer AD, Jabbour N, Visoiu M, Yang CI, Yellon RF (2016) Paravertebral Nerve Block for Donor Site Pain in Stage I Microtia Reconstruction: A Pilot Study. Otolaryngol Head Neck Surg 154(5):898–901CrossRef Shaffer AD, Jabbour N, Visoiu M, Yang CI, Yellon RF (2016) Paravertebral Nerve Block for Donor Site Pain in Stage I Microtia Reconstruction: A Pilot Study. Otolaryngol Head Neck Surg 154(5):898–901CrossRef
4.
Zurück zum Zitat Uto S, Hikita A, Sakamoto T, Mori D, Yano F, Ohba S, Saito T, Takato T, Hoshi K (2021) Ear cartilage reconstruction combining induced pluripotent stem cell-derived cartilage and three-dimensional shape-memory scaffold. Tissue Eng Part A 27(9–10):604–617CrossRef Uto S, Hikita A, Sakamoto T, Mori D, Yano F, Ohba S, Saito T, Takato T, Hoshi K (2021) Ear cartilage reconstruction combining induced pluripotent stem cell-derived cartilage and three-dimensional shape-memory scaffold. Tissue Eng Part A 27(9–10):604–617CrossRef
5.
Zurück zum Zitat Niiyama Y, Yotsuyanagi T, Yamakage M (2016) Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia. J Plast Reconstr Aesthet Surg 69(10):1445-1449 Niiyama Y, Yotsuyanagi T, Yamakage M (2016) Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia. J Plast Reconstr Aesthet Surg 69(10):1445-1449
6.
Zurück zum Zitat Woo KJ, Kang BY, Min JJ, Park JW, Kim A, Oh KS (2016) Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: A randomized controlled trial. J Plast Reconstr Aesthet Surg 69(9):1203–1210CrossRef Woo KJ, Kang BY, Min JJ, Park JW, Kim A, Oh KS (2016) Postoperative pain control by preventive intercostal nerve block under direct vision followed by catheter-based infusion of local analgesics in rib cartilage harvest for auricular reconstruction in children with microtia: A randomized controlled trial. J Plast Reconstr Aesthet Surg 69(9):1203–1210CrossRef
7.
Zurück zum Zitat Gado AA, Abdalwahab A, Ali H, Alsadek WM, Ismail AA (2021) Serratus anterior plane block in pediatric patients undergoing thoracic surgeries: a randomized controlled trial. J Cardiothorac Vasc Anesth 35(7):2088–2093 Gado AA, Abdalwahab A, Ali H, Alsadek WM, Ismail AA (2021) Serratus anterior plane block in pediatric patients undergoing thoracic surgeries: a randomized controlled trial. J Cardiothorac Vasc Anesth 35(7):2088–2093
8.
Zurück zum Zitat Kovac AL (2021) Postoperative nausea and vomiting in pediatric patients. Paediatr Drugs 23(1):11–37CrossRef Kovac AL (2021) Postoperative nausea and vomiting in pediatric patients. Paediatr Drugs 23(1):11–37CrossRef
9.
Zurück zum Zitat Liang XL, An R, Chen Q, Liu HL (2021) The analgesic effects of thoracic paravertebral block versus thoracic epidural anesthesia after thoracoscopic surgery: a meta-analysis. J Pain Res 14:815–825CrossRef Liang XL, An R, Chen Q, Liu HL (2021) The analgesic effects of thoracic paravertebral block versus thoracic epidural anesthesia after thoracoscopic surgery: a meta-analysis. J Pain Res 14:815–825CrossRef
10.
Zurück zum Zitat Kaushal B, Chauhan S, Saini K, Bhoi D, Bisoi AK, Sangdup T, Khan MA (2019) Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves ii block, and intercostal nerve block for the management of postoperative thoracotomy pain after pediatric cardiac surgery. J Cardiothorac Vasc Anesth 33(2):418–425CrossRef Kaushal B, Chauhan S, Saini K, Bhoi D, Bisoi AK, Sangdup T, Khan MA (2019) Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves ii block, and intercostal nerve block for the management of postoperative thoracotomy pain after pediatric cardiac surgery. J Cardiothorac Vasc Anesth 33(2):418–425CrossRef
11.
Zurück zum Zitat Anantanarayanan P, Raja DK, Kumar JN, Sneha P, Christabel A, Manikandhan R, Elavazhagan N (2013) Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine. J Oral Maxillofac Surg 71(1):29–34CrossRef Anantanarayanan P, Raja DK, Kumar JN, Sneha P, Christabel A, Manikandhan R, Elavazhagan N (2013) Catheter-based donor site analgesia after rib grafting: a prospective, randomized, double-blinded clinical trial comparing ropivacaine and bupivacaine. J Oral Maxillofac Surg 71(1):29–34CrossRef
12.
Zurück zum Zitat Blanco R, Parras T, McDonnell JG, Prats-Galino A (2013) Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 68(11):1107–1113CrossRef Blanco R, Parras T, McDonnell JG, Prats-Galino A (2013) Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 68(11):1107–1113CrossRef
13.
Zurück zum Zitat De Cassai A, Boscolo A, Zarantonello F, Piasentini E, Di Gregorio G, Munari M, Persona P, Zampirollo S, Zatta M, Navalesi P (2021) Serratus anterior plane block for video-assisted thoracoscopic surgery: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 38(2):106–114CrossRef De Cassai A, Boscolo A, Zarantonello F, Piasentini E, Di Gregorio G, Munari M, Persona P, Zampirollo S, Zatta M, Navalesi P (2021) Serratus anterior plane block for video-assisted thoracoscopic surgery: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 38(2):106–114CrossRef
16.
Zurück zum Zitat Almeida CR (2021) Serratus anterior plane block for posterior rib fractures: why and when may it work? Reg Anesth Pain Med 46(9):835–836CrossRef Almeida CR (2021) Serratus anterior plane block for posterior rib fractures: why and when may it work? Reg Anesth Pain Med 46(9):835–836CrossRef
17.
Zurück zum Zitat Mayes J, Davison E, Panahi P, Patten D, Eljelani F, Womack J, Varma M (2016) An anatomical evaluation of the serratus anterior plane block. Anaesthesia 71(9):1064–1069CrossRef Mayes J, Davison E, Panahi P, Patten D, Eljelani F, Womack J, Varma M (2016) An anatomical evaluation of the serratus anterior plane block. Anaesthesia 71(9):1064–1069CrossRef
18.
Zurück zum Zitat Biswas A, Castanov V, Li Z, Perlas A, Kruisselbrink R, Agur A, Chan V (2018) Serratus plane block: a cadaveric study to evaluate optimal injectate spread. Reg Anesth Pain Med 43(8):854–858PubMed Biswas A, Castanov V, Li Z, Perlas A, Kruisselbrink R, Agur A, Chan V (2018) Serratus plane block: a cadaveric study to evaluate optimal injectate spread. Reg Anesth Pain Med 43(8):854–858PubMed
19.
Zurück zum Zitat Breivik H, Stubhaug A (2008) Management of acute postoperative pain: still a long way to go! Pain 137(2):233–234CrossRef Breivik H, Stubhaug A (2008) Management of acute postoperative pain: still a long way to go! Pain 137(2):233–234CrossRef
23.
Zurück zum Zitat Kupeli I, Adilović AŠ (2021) The “feasibility” and “safety” of ultrasound guided bilateral two level serratus anterior plane block in children with median sternotomy pain: a case series. J Cardiothorac Vasc Anesth 35(1):270–273CrossRef Kupeli I, Adilović AŠ (2021) The “feasibility” and “safety” of ultrasound guided bilateral two level serratus anterior plane block in children with median sternotomy pain: a case series. J Cardiothorac Vasc Anesth 35(1):270–273CrossRef
24.
Zurück zum Zitat Chen GD, Li YF, Zhang YX, Fang XM (2019) Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial. J Pain Res 12:2411–2417CrossRef Chen GD, Li YF, Zhang YX, Fang XM (2019) Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial. J Pain Res 12:2411–2417CrossRef
25.
Zurück zum Zitat Fiore JF, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, Figueiredo AG, Valanci S, Marquez-GdeV JA, Schulz M et al (2019) Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia. Br J Anaesth 123(5):627–636CrossRef Fiore JF, Olleik G, El-Kefraoui C, Verdolin B, Kouyoumdjian A, Alldrit A, Figueiredo AG, Valanci S, Marquez-GdeV JA, Schulz M et al (2019) Preventing opioid prescription after major surgery: a scoping review of opioid-free analgesia. Br J Anaesth 123(5):627–636CrossRef
26.
Zurück zum Zitat Rocca GD, Chiarandini P, Pietropaoli P (2005) Analgesia in PACU: nonsteroidal anti-inflammatory drugs. Curr Drug Targets 6(7):781–787CrossRef Rocca GD, Chiarandini P, Pietropaoli P (2005) Analgesia in PACU: nonsteroidal anti-inflammatory drugs. Curr Drug Targets 6(7):781–787CrossRef
27.
Zurück zum Zitat Piracha MM, Thorp SL, Puttanniah V, Gulati A (2017) “A tale of two planes”: deep versus superficial serratus plane block for postmastectomy pain syndrome. Reg Anesth Pain Med 42(2):259–262CrossRef Piracha MM, Thorp SL, Puttanniah V, Gulati A (2017) “A tale of two planes”: deep versus superficial serratus plane block for postmastectomy pain syndrome. Reg Anesth Pain Med 42(2):259–262CrossRef
28.
Zurück zum Zitat Abdallah FW, Cil T, MacLean D, Madjdpour C, Escallon J, Semple J, Brull R (2018) Too deep or not too deep?: a propensity-matched comparison of the analgesic effects of a superficial versus deep serratus fascial plane block for ambulatory breast cancer surgery. Reg Anesth Pain Med 43(5):480–487PubMed Abdallah FW, Cil T, MacLean D, Madjdpour C, Escallon J, Semple J, Brull R (2018) Too deep or not too deep?: a propensity-matched comparison of the analgesic effects of a superficial versus deep serratus fascial plane block for ambulatory breast cancer surgery. Reg Anesth Pain Med 43(5):480–487PubMed
30.
Zurück zum Zitat Desai M, Narayanan MK, Venkataraju A (2020) Pneumothorax following serratus anterior plane block. Anaesth Rep 8(1):14–16CrossRef Desai M, Narayanan MK, Venkataraju A (2020) Pneumothorax following serratus anterior plane block. Anaesth Rep 8(1):14–16CrossRef
31.
Zurück zum Zitat Chaudhary V, Chauhan S, Choudhury M, Kiran U, Vasdev S, Talwar S (2012) Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study. J Cardiothorac Vasc Anesth 26(3):439–442CrossRef Chaudhary V, Chauhan S, Choudhury M, Kiran U, Vasdev S, Talwar S (2012) Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study. J Cardiothorac Vasc Anesth 26(3):439–442CrossRef
32.
Zurück zum Zitat Desai N, Kirkham KR, Albrecht E (2021) Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review. Anaesthesia 76(Suppl 1):100–109CrossRef Desai N, Kirkham KR, Albrecht E (2021) Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review. Anaesthesia 76(Suppl 1):100–109CrossRef
33.
Zurück zum Zitat Castarlenas E, Jensen MP, von Baeyer CL, Miró J (2017) Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: a systematic review. Clin J Pain 33:376–383CrossRef Castarlenas E, Jensen MP, von Baeyer CL, Miró J (2017) Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: a systematic review. Clin J Pain 33:376–383CrossRef
34.
Zurück zum Zitat Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN (2019) Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties. Pain 160(1):5–18CrossRef Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN (2019) Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties. Pain 160(1):5–18CrossRef
35.
Zurück zum Zitat Sánchez-Rodríguez E, Miró J, Castarlenas E (2012) A comparison of four self-report scales of pain intensity in 6- to 8-year-old children. Pain 153:1715–1719CrossRef Sánchez-Rodríguez E, Miró J, Castarlenas E (2012) A comparison of four self-report scales of pain intensity in 6- to 8-year-old children. Pain 153:1715–1719CrossRef
Metadaten
Titel
Ultrasound-guided Bilateral Serratus Anterior Plane Block for Postoperative Analgesia in Ear Reconstruction after Costal Cartilage Harvest: A Randomized Controlled Trial
verfasst von
Chunmei Chen
Guihua Xiang
Keyu Chen
Quanle Liu
Xiaoming Deng
Hang Zhang
Dong Yang
Fuxia Yan
Publikationsdatum
02.08.2022
Verlag
Springer US
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 4/2022
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-022-03027-x

Weitere Artikel der Ausgabe 4/2022

Aesthetic Plastic Surgery 4/2022 Zur Ausgabe

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.