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Observational Study
. 2019 Jul 6;19(1):120.
doi: 10.1186/s12871-019-0797-4.

Comparison of several methods for pain management after video-assisted thoracic surgery for pneumothorax: an observational study

Pierre-Antoine Allain  1 , Michele Carella  1 , Apostolos C Agrafiotis  2 , Julien Burey  1   3 , Jalal Assouad  2   3 , El-Mahdi Hafiani  1 , Yacine Ynineb  1 , Francis Bonnet  1   3 , Marc Garnier  4   5 , Christophe Quesnel  1   3
Affiliations
Observational Study

Comparison of several methods for pain management after video-assisted thoracic surgery for pneumothorax: an observational study

Pierre-Antoine Allain et al. BMC Anesthesiol. .

Abstract

Background: There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been proposed but remain poorly evaluated in this context. We aimed to assess the analgesic efficacy of several of these techniques for the management of postoperative pain.

Methods: We conducted a monocentric prospective observational cohort study from February 2017 to April 2018 in patients suffering from spontaneous pneumothorax and scheduled for VATS (n = 59). Patients received systemic analgesia (i) alone (n = 15); (ii) combined with a continuous paravertebral block (n = 9); (iii) combined with a continuous serratus plane block (n = 19); or (iv) single-shot serratus plane block (n = 16) as decided by the attending physician. Pain scores and analgesic-related side effects were prospectively collected by an independent observer during the first postoperative 72 h. The primary endpoint criterion was the cumulative oral morphine consumption at the end of the third postoperative day. Statistical analysis used univariate and multivariate step-by-step forward logistic regression models to determine risk factors associated with the main criteria.

Results: Mean pain scores and morphine consumption were not significantly different between the 4 groups. In the multivariate analysis, the use of a continuous serratus plane block through a catheter was the only technique associated with a reduced incidence of high-dose oral morphine consumption (OR 0.09-95%CI [0.01-0.79], p = 0.03).

Conclusion: This study suggests that serratus plane block combined with continuous infusion through a catheter may have some benefits, although further studies are needed to confirm these results and determine the true place of the serratus plane block in pain management after VATS for pneumothorax.

Keywords: Paravertebral block; Pneumothorax; Postoperative pain; Serratus plane block; Video-assisted thoracic surgery.

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Conflict of interest statement

Francis Bonnet and Marc Garnier are members of the editorial board (Associate Editor) of this journal. All other authors declare that they have no competing interest in relation with the subject of the manuscript.

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Daily and cumulative oral morphine consumption during the first postoperative 72 h according to the postoperative analgesic technique used
See this image and copyright information in PMC

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