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Abstract
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Background and Aims Introduction Regional anesthesia techniques (thoracic, epidural, paravertebral) in non cardiac thoracic surgery enhances perioperative analgesia, early extubation and shorten hospital length of stay. However the failure rates and risk of pneumothorax causes these techniques sometimes avoided among Pediatric population. Ultrasound guided Serratus Anterior Plane Block (SAPB) is an alternative that provide satisfactory perioperative analgesia for infants undergoing non-cardiac thoracic surgery.
Methods An 1 year old 9kg infant was diagnosed with congenital multicystic lung lesion of right upper lobe planned for open right thoracotomy. With informed consent ,he was planned for operation under general anaesthesia with right SAPB. He was induced with with IV Fentanyl 10mcg, IV Propofol 20mg and IV Atracurium 4mg. On the left lateral position, Ultrasound guided SAPB was done prior surgical incision with Sonoplex Pajunk 50mm and 4mL of Levobupivacaine 0.25% ( 10mg ) injected in between Serratus muscle and Latissimus dorsi muscles at level of T5 . Intraoperatively, IV Paracetamol 135mg (15mg/kg) and IV Morphine 0.2mg was given as additional analgesic during manipulation and resection of the lung parenchyma. His hemodynamic were stable through out the surgery. Post operatively, patient was transferred to PICU and ventilate overnight with IV Morphine 50mcg/hour as sedation. He was extubated to nasal prong 2 litres/min subsequent day. He was transferred to general ward after 3 days stay in PICU and was discharged well after 7 days of hospitalisation.
Infant at Left Lateral Position
Right Upper Lobe congenital multi cystic lesion
Serratus Anterior Plane Block at T5 T6
Conclusions Ultrasound guided Serratus Anteriod Plane Block (SAPB) is and effective, simple, relatively safe analgesic adjunct for infants undergoing non-cardiac thoracic surgery