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      Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial

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          Abstract

          Background

          Serratus anterior plane (SAP) block is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve.

          Purpose

          Our study aimed to evaluate the effects of SAP block on postoperative pain after thoracoscopic surgery compared with local anesthetic (LA) infiltration.

          Patients and methods

          Forty adult patients undergoing video-assisted thoracic surgery were randomized to receive either SAP block (n=20) or LA infiltration of incision (n=20). The primary outcome was postoperative visual analog scale (VAS) score at the 2nd, 8th, 16th, 24th, and 48th hour after surgery. The secondary outcomes were the consumption of sufentanil at 8th, 16th, 24th hours postoperative. In addition, rescue analgesia, drug-related adverse effects after surgery was also analyzed.

          Results

          The SAP group showed lower VAS scores at the 2nd hour (at rest: SAP group 11 [8–13] vs LA group 28 [26–32], P=0.01; on coughing: 15 [13–18] vs 33 [26–38], P=0.01) and the 8th hour (at rest: 13 [12–18] vs 36 [32–46], P=0.01; on coughing: 19 [16–23] vs 42 [36–53], P=0.01) after surgery. Postoperative sufentanil consumption in the SAP group during 0–8 hrs was significantly lower compared with the LA group ( P<0.01). The use of rescue analgesia was also significantly lower in the SAP group ( P=0.02) during 0–12 hrs.

          Conclusion

          Compared to LA infiltration, ultrasound-guided SAP block may provide better pain relief as well as reduce opioid consumption after thoracoscopic surgery.

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          Most cited references 17

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          Neuronal plasticity: increasing the gain in pain.

          We describe those sensations that are unpleasant, intense, or distressing as painful. Pain is not homogeneous, however, and comprises three categories: physiological, inflammatory, and neuropathic pain. Multiple mechanisms contribute, each of which is subject to or an expression of neural plasticity-the capacity of neurons to change their function, chemical profile, or structure. Here, we develop a conceptual framework for the contribution of plasticity in primary sensory and dorsal horn neurons to the pathogenesis of pain, identifying distinct forms of plasticity, which we term activation, modulation, and modification, that by increasing gain, elicit pain hypersensitivity.
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            Evidence for a central component of post-injury pain hypersensitivity

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              Failed epidural: causes and management.

              Failed epidural anaesthesia or analgesia is more frequent than generally recognized. We review the factors known to influence the success rate of epidural anaesthesia. Reasons for an inadequate epidural block include incorrect primary placement, secondary migration of a catheter after correct placement, and suboptimal dosing of local anaesthetic drugs. For catheter placement, the loss of resistance using saline has become the most widely used method. Patient positioning, the use of a midline or paramedian approach, and the method used for catheter fixation can all influence the success rate. When using equipotent doses, the difference in clinical effect between bupivacaine and the newer isoforms levobupivacaine and ropivacaine appears minimal. With continuous infusion, dose is the primary determinant of epidural anaesthesia quality, with volume and concentration playing a lesser role. Addition of adjuvants, especially opioids and epinephrine, may substantially increase the success rate of epidural analgesia. Adjuvant opioids may have a spinal or supraspinal action. The use of patient-controlled epidural analgesia with background infusion appears to be the best method for postoperative analgesia.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                01 August 2019
                2019
                : 12
                : 2411-2417
                Affiliations
                [1 ]Department of Anesthesiology and Intensive Care, The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou 310003, People’s Republic of China
                [2 ]Department of Anesthesiology, Zhejiang Province Hospital of Integrated Traditional Chinese and Western Medicine , Hangzhou 310003, People’s Republic of China
                Author notes
                Correspondence: Xiangming FangDepartment of Anesthesiology and Intensive Care Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine , No. 79 Qing Chun Road, Hangzhou310003, People’s Republic of ChinaTel +86 5 718 820 8006Email xmfang@ 123456zju.edu.cn
                Article
                207116
                10.2147/JPR.S207116
                6682177
                © 2019 Chen et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 3, References: 20, Pages: 7
                Categories
                Original Research

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