Pectoralis and Serratus Nerves Block in Thoracic Surgery

Study Overview
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Brief Summary
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A new conceptual regional anesthesia the PECs II block (modified pectoral and serratus nerves block) has been described for pain control after thoracic surgery, one of the indications to perform this method is analgesia for surgeries or procedures involving lateral chest wall

Detailed Description
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The PECs I block was found to be very effective after breast cancer surgery and sub-pectoral prosthesis for pain control management. This block is provided by injection into another myofascial plane, this time between pectoralis minor and serratus anterior muscle at the level of 3rd and 4th rib.PECs II block is simple in performance with a high success rate and minimal incidence of complications, especially, if used ultrasound approach that gives a good understanding of anatomy of the lateral thoracic wall. In present clinical trial we are going to compare PECs block for pain control with traditional pain management techniques based on IV opioids and NSAIDs treatment in patient undergoing thoracic surgery in early postoperative period.

Official Title
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Ultrasound Guided PECs II (Pectoralis and Serratus Nerves) Block in Patients Undergoing a Thoracic Surgery

Conditions
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Anesthesia, Surgery, Block, Thoracic Injury

Intervention / Treatment
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* Drug: Bupivacaine Hydrochloride
* Device: Ultrasound
* Procedure: Thoracotomy
* Drug: Opioids
* Drug: NSAID


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients undergoing thoracic surgery, older ≥18 years Patients who meet criteria of ASA I-II-III class. Exclusion Criteria: Patients who will be unconscious or mentally incompetent Patients refusal to participate in the study ASA -IV -V Patient with coagulopathy Hemodynamically unstable (systolic BP < 90, HR > 100) Allergy to local anesthetic drugs or opioids Pregnant patient History of opioid abuse

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pectoralic block group<br>After general anesthesia, 40ml of 0.25% Bupivacaine Hydrochloride will be administered before procedure Thoracotomy. Block will be administrated between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib., in assistance of ultrasound for visualization anesthetic injection point. | Drug: Bupivacaine Hydrochloride<br>* 40 cc 0.25% of Bupivacaine Hydrochloride injection using ultrasound approach will be administered between pectoralis minor and serratus anterior muscle at the 3rd and 4th rib<br>* Other names: Marcaine;Device: Ultrasound<br>* All blocks will be done under ultrasound<br>* Other names: Sonosite;Procedure: Thoracotomy<br>* The patient population will include patients that undergo either open thoracotomy or thoracoscopy for anatomic and non-anatomic lung resection. The standard thoracoscopy approach in our institute includes three holes technic. There are two incisions of 1 cm and utility incision of 4 cm. The standard thoracotomy is posterior- lateral thoracotomy which divided the latissimus dorsi muscle but spears the serratus anterior muscle.<br>Drug: Opioids<br>* standard pain control with opioids<br>* Other names: Morphine;Drug: NSAID<br>* standard pain control with NSAIDs<br>* Other names: Perfalgan;|
| Active Comparator: Control group<br>Patients in this group will receive standard pain control with opioids and NSAIDs | Procedure: Thoracotomy<br>* The patient population will include patients that undergo either open thoracotomy or thoracoscopy for anatomic and non-anatomic lung resection. The standard thoracoscopy approach in our institute includes three holes technic. There are two incisions of 1 cm and utility incision of 4 cm. The standard thoracotomy is posterior- lateral thoracotomy which divided the latissimus dorsi muscle but spears the serratus anterior muscle.<br>Drug: Opioids<br>* standard pain control with opioids<br>* Other names: Morphine;Drug: NSAID<br>* standard pain control with NSAIDs<br>* Other names: Perfalgan;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison Visual Analog Score between groups | First VAS after admission in PACU | First 24 hours from the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total NSAIDs dosage (mg) in the PACU and department | While the patient is in PACU | First 24 hours from the surgery | 
| Length of hospital stay | Measuring time of at discharge from hospital | up to 21 days | 
| Total morphine dosage (mg) in the PACU and department | While the patient is in PACU | First 24 hours from the surgery |