Efficacy Between Serratus Plane Block And Local Infiltration In Vats

Robotic video-assisted thoracoscopic surgery (VATS) is increasingly being used as it is a
less invasive surgery compared to traditional methods, but the acute pain at an early stage
after VATS has a major impact on perioperative outcomes. Effective post operative analgesia
is believed to reduce morbidity, quicken recovery, improve patient outcome and reduce
hospital costs. The site and extent of the incision influences the degree of pain due to
disruption of intercostal nerves as well as inflammation of chest wall and pleura. Neuraxial
and systemic opioids have been a gold standard as a part of multimodal analgesia for thoracic
surgeries. Numerous modalities have been studied: thoracic paravertebral nerve blocks,
thoracic epidural analgesia, intercostal nerve blocks, patient controlled analgesia (PCA),
cryo-analgesia, transcutaneous electrical nerve stimulation (TENS), inter-pleural blocks,
stellate ganglion blocks, long thoracic nerve blocks, and infiltration under direct vision by
the surgeon.

Serratus plane block is an emerging regional technique that has proven to be effective in
comparison to paravertebral blocks in patients undergoing breast surgery and mastectomy with
reduced perioperative opioid consumption and improved pain scores.

The lateral pectoral nerve, medial pectoral nerve, intercostal nerves and long thoracic nerve
are all targets for the serratus plane block. It can be safely performed under ultrasound
guidance.

The purpose of the study is to evaluate the difference in quality of analgesia between
efficacy of serratus plane block and local surgical infiltration by surgeon as measured by
patient opioid consumption and pain scores.