Assessment of Ultrasound-Guided Continuous Low Serratus Anterior Plane Block for Pain Management After Hepatectomy: A Randomized Controlled Trial

Abstract

Purpose

Adequate postoperative analgesia is a key to earlier recovery from open surgery. This work investigated the pain control and quality of patient recovery after hepatectomy to evaluate the modified continuous serratus anterior plane block (called low SAPB) for postoperative analgesia.

Patients and Methods

This single-center, blinded, randomized, controlled study included 136 patients who underwent hepatectomy under general anesthesia. For postoperative analgesia, the patients in the SAPB group were given a continuous low SAPB at the 7th intercostal space in the right mid-axillary line, and the patients in the control group were given continuous intravenous opioid analgesia. The numeric pain rating scale (NPRS) was used for pain assessment. The postoperative assessment focused on the remedial drug consumption, the occurrence of adverse postoperative analgesic reactions, and the quality of patient recovery evaluated with the QoR-15 questionnaire.

Results

Compared to the controls, the SAPB patients had significantly lower NPRS scores at 12 h and 24 h at rest and 6 h, 12 h, and 24 h in motion, and a longer time to first use of remedial analgesics at 24 h, and higher overall QoR-15 scores at 24 h [124 (121, 126) vs 121 (120, 124)] and 48 h [129 (126, 147) vs 126 (125, 128)], after surgery. There was no significant difference in the incidence of analgesia-related adverse reactions between the two groups.

Conclusion

The continuous low SAPB could achieve superior pain control, especially for motor pain, to intravenous opioid analgesia during the first 24 h post-surgery. Even with no significant difference in the incidence of postoperative adverse reactions, patients with continuous low SAPB appeared to have a higher quality of recovery in the first two days post-surgery than patients with continuous intravenous analgesia.

Keywords:

• liver resection
• postoperative analgesia
• serratus anterior plane block

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

This prospective, randomized, controlled, single-blind trial was approved by the Institutional Ethics Committee (approval number: 2021-01) of the First People’s Hospital of Neijiang (Sichuan, China) and was conducted in accordance with the principles outlined in the Declaration of Helsinki. This trial was preregistered on clinicaltrials.gov (Trial registration number: NCT05531864).

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Research Program of the Sichuan Provincial Health Commission, Sichuan, China (No. 20PJ288), and the Sichuan Medical Association Youth Research Innovation Fund Project (No. Q22022).