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Background and Aims Thoracic sympathectomy (TS) stands as a primary treatment for localized hyperhidrosis. At our institution, TS is performed under general anesthesia with a systemic multimodal analgesic regimen on an outpatient basis. However, the procedure can lead to moderate postoperative pain due to trocar insertion into intercostal spaces, carbon dioxide insufflation, and manipulation of the parietal pleura, often necessitating escalated opioid doses with associated adverse effects. This report details two cases of TS conducted under general anesthesia, supplemented with bilateral ultrasound-guided serratus anterior plane block (SAPB).

Methods Two 20-year-old female patients underwent TS under general anesthesia. Following informed consent, bilateral ultrasound-guided SAPB was administered using 20 mL of 0.5% ropivacaine. Intraoperative intravenous analgesia included magnesium sulfate (2 g), acetaminophen (1 g), metamizol (2 g), ketorolac (30 mg), ketamine (20 mg), and dexamethasone (8 mg). Both surgeries proceeded without intraoperative pain, with Patient A reporting a postoperative pain score of 2/10 and Patient B reporting 4/10, managed with a single 2 mg dose of intravenous morphine. At discharge and during the 24-hour follow-up, both patients reported pain scores of 0/10, maintained with oral acetaminophen and celecoxib, with no reported side effects.

Results SAPB proved its efficacy as a component of multimodal analgesia for TS, reducing opioid dose throughout the perioperative period.

Conclusions Effective multimodal analgesia is crucial for successful ambulatory surgery. SAPB, offering substantial anterolateral chest wall analgesia, presents as a promising option for ambulatory procedures, given its minimally invasive nature and lower complication rates. Further research is needed to substantiate these findings.