Ultrasound-guided thoracic pectoral and serratus plane blocks: new approaches to reducing postoperative pain

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Background: pectoralis nerve and serratus plane blocks (PECS) are newer ultrasound guided regional anesthesia techniques of the thorax. Aim: evaluate and consolidate scientific evidence of ultrasound-guided thoracic PECS or modified PECS block-serratus anterior plane block effect on postoperative pain in comparison with other comparison intervention. Methods: we searched 8 electronic databases: Medline, Cochrane, Scopus, Embase, Web of Science, CINAHL, ESCI and ILISI. Three of the authors independently selected trials, assessed the risk of bias, and extracted data. Results: final analysis included thirteen trials. When the PECS block is effective, an optimal duration of analgesia has been reported in the first 24 hours after surgery. PECS block (or its modifications) has a significant pain effect in the postoperative period. However, paravertebral block (PVB) has slightly better efficacy at 18 h and 24 h (p = 0.008 and <0.001 respectively) compared with PECS block. Conclusions: the PECS block produced excellent analgesia, often if combined with general anesthesia for breast surgery. PECS block could be recommended as an alternative to intravenous normal anesthesia in certain breast surgeries for pain postoperative management.

Key words: thoracic surgery, pectoral blocks, serratus plane block, postoperative pain, regional anesthesia, opioid.

Received: September 10, 2018

Accepted: October 10, 2018

DOI: 10.19190/PNM2018.1_ra10