Published in:
01-06-2020 | Fentanyl | Letter to the Editor
Regional Analgesia Technique for Post-Thoracotomy Pain
Published in: Indian Journal of Surgical Oncology | Issue 2/2020
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I read the recently published case series in Indian Journal of Surgical Oncology on “Serratus Anterior Plane Block for Post-Thoracotomy Analgesia: A Novel Technique for the Surgeon and Anaesthetist” by Vig et al. with interest [1]. I would like to congratulate and thank the authors for sharing their research work. However, it is important to note some aspects about analgesia in thoracotomy:
1.
Authors have mentioned serratus anterior plane block (SAPB) for post-thoracotomy analgesia as a ‘novel’ technique, which is not appropriate. Okmen et al. used continuous SAPB for management of thoracotomy pain [2].
2.
3.
According to the authors, four out of 10 patients (40%) required intravenous fentanyl infusion in spite of continuous SAPB (5–7 ml/h) with 0.125% ropivacaine with fentanyl (1 mcg/h). Considering the severity of post-thoracotomy pain, the concentration of ropivacaine infusion was suboptimal. It would have been better controlled if the concentration were ≥ 0.2%. Hence, preemptive use of regional analgesia along with multimodal analgesia and/or additional drain site infiltration would offer better pain management in patients undergoing thoracotomy.
4.
Recently, Tulgar et al. [5] described ultrasound-guided single and bi-level erector spinae plane block (ESPB) for postoperative analgesia in thoracotomy. ESPB is a promising regional analgesic technique which can be performed away from the surgical site and provide good analgesia to hemithorax. However, prospective randomised clinical trial comparing with other techniques is warranted.