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  • Additive value of superficial parasternal intercostal plane block and serratus anterior plane block in lung transplantation surgery: a retrospective exploratory study

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Additive value of superficial parasternal intercostal plane block and serratus anterior plane block in lung transplantation surgery: a retrospective exploratory study
  1. Karam Azem1,2,
  2. Shai Fein1,2,
  3. Benjamin Zribi1,2,
  4. Daniel Iluz-Freundlich1,2,
  5. Ido Neuman1,2,
  6. Michal Y Livne1,2,
  7. Omer Kaplan1,2,
  8. Roussana Aranbitski1,2,
  9. Philip Heesen3,
  10. Liran Statlender2,4,
  11. Dan Gorfil2,5,
  12. Yaron Barac2,5,
  13. Yuri Peysakhovich2,5 and
  14. Eitan Mangoubi1,2
  1. 1Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
  2. 2Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3Faculty of Medicine, University of Zurich, Zurich, Switzerland
  4. 4Department of Intensive Care, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
  5. 5Department of Cardiothoracic Surgery, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
  1. Correspondence to Dr Karam Azem, Department of Anesthesiology, Rabin Medical Center Beilinson Hospital, Petah Tikva, Central, Israel; drazemk{at}gmail.com

Abstract

Background Adequate pain control following lung transplantation (LTx) surgery is paramount. Thoracic epidural analgesia (TEA) is the gold standard; however, the potential use of extracorporeal membrane oxygenation (ECMO) and consequent anticoagulation therapy raises safety concerns, prompting clinicians to seek safer alternatives. The utility of thoracic wall blocks in general thoracic surgery is well established; however, their role in the context of LTx has been poorly investigated.

Methods In this retrospective exploratory study, we assessed the effect of adding a superficial parasternal intercostal plane (sPIP) block and serratus anterior plane (SAP) block to standard anesthetic and analgesic care on tracheal extubation rates, pain scores and opioid consumption until 72 hours postoperatively in LTx.

Results Sixty patients were included in the analysis; 35 received the standard anesthetic and analgesic care (control group), and 25 received sPIP and SAP blocks in addition to the standard anesthetic and analgesic care (intervention group). We observed higher tracheal extubation rates in the intervention group at 8 hours postoperatively (16.0% vs 0.0%, p=0.03). This was also shown after adjusting for known prognostic factors (OR 1.18; 95% CI 1.04 to 1.33, p=0.02). Furthermore, we noted a lower opioid consumption measured by morphine milligram equivalents at 24 hours in the intervention group (median 405 (IQR 300–490) vs 266 (IQR 168–366), p=0.02). This was also found after adjusting for known prognostic factors (β −118; 95% CI −221 to 14, p=0.03).

Conclusion sPIP and SAP blocks are safe regional analgesic techniques in LTx involving ECMO and clamshell incision. They are associated with faster tracheal extubation and lower opioid consumption. These techniques should be considered when TEA is not appropriate. Further high-quality studies are warranted to confirm these findings.

  • regional anesthesia
  • pain, postoperative
  • analgesics, opioid
  • pain management

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2023-105137

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @DrAzemK, @philipheesen

    • KA and SF contributed equally.

    • Contributors Guarantor: EM. Conceptualisation: KA, SF, BZ, RA, DG, YB, YP, EM. Data curation: KA, BZ, DI-F, IN, MYL, OK, LS. Formal analysis: DI-F, IN, LS, PH. Methodology: KA, SF, BZ, RA, EM, DG, YB, YP, EM. Project administration: EM. Supervision and validation: KA, SF, BZ, IN, OK, RA, DG, EM. Writing the original draft: KA, SF, DI-F, OK, EM. All authors have reviewed, edited and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.