Ultrasound-guided Deep and Superficial Serratus Anterior Plane Block

Study Overview
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Brief Summary
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This study evaluates the difference of deep and superficial serratus anterior plane block on intraoperative opioid consumption, emergence time and hemodynamic stability in patients undergoing video-assisted thoracic surgery.

Detailed Description
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Thoracotomy is known as one of the most painful surgery. Thus, there is a development to reduce surgical stress in terms of operation technique, which is video-assisted thoracoscopic surgery. Although it has reduced postoperative pain and complications compared with thoracotomy, VATS is still quite painful operation. Serratus plane block is a novel technique which provide analgesic effect for lateral chest wall by blocking lateral branch of intercostal nerve. Two methods were proposed to target the top and bottom of the serratus anterior muscle. However, the difference of deep and superficial serratus anterior plane block during intraoperative period has not yet been studied. In this study, therefore, the investigators decided to assess the difference of deep and superficial serratus anterior plane block on intraoperative opioid consumption, emergence time and hemodynamic stability in patients undergoing video-assisted thoracic surgery.

Official Title
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Comparison of Intraoperative Opioid Consumption, Emergence Time and Hemodynamic Stability Between Ultrasound-guided Deep and Superficial Serratus Anterior Plane Block During Video-assisted Thoracoscopic Lobectomy

Conditions
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Pain Management, Thoracotomy

Intervention / Treatment
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* Procedure: Deep Serratus Anterior Plane Block
* Procedure: Superficial Serratus Anterior Plane Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a) American Society of Anesthesiologists (ASA) physical status 1 or 2 b) age 20-75 years c) elective three port Video-assisted thoracoscopic surgery (VATS) lobectomy. Exclusion Criteria: a) a history of drug allergy for opioids or local anesthetics b) local infection at the injection site and systemic infection c) coagulopathy d) difficulty in understanding the study protocol e) refusal to participate

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 75 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Deep Serratus Anterior Plane Block<br>Deep Serratus Anterior Plane Block was performed just before the start of surgery after anesthetic induction through ultrasound-guidance. 20ml of 0.375% ropivacaine was slowly injected between the fascia of serratus anterior and external intercostal muscle near 5th rib. | Procedure: Deep Serratus Anterior Plane Block<br>* Deep Serratus Anterior Plane Block was performed just before the start of surgery after anesthetic induction through ultrasound-guidance.<br>|
| Active Comparator: Superficial Serratus Anterior Plane Block<br>Superficial Serratus Anterior Plane Block was performed just before the start of surgery after anesthetic induction through ultrasound-guidance. 20ml of 0.375% ropivacaine was slowly injected between the fascia of serratus anterior and latissimus dorsi near 5th rib. | Procedure: Superficial Serratus Anterior Plane Block<br>* Superficial Serratus Anterior Plane Block was performed just before the start of surgery after anesthetic induction through ultrasound-guidance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intraoperative remifentanil consumption | Intraoperative remifentanil consumption will be checked. | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emergence time | Emergence time is duration between the end of surgery and extubation. Emergence time will be checked. | through study completion, an average of 1 year | 
| Systolic blood pressure | Systolic blood pressure (mmHg) will be checked | through study completion, an average of 1 year | 
| Heart rate (HR) Heart rate | Heart rate (beats per minute) will be checked | through study completion, an average of 1 year | 
| Dose of rescue drugs used to control blood pressure and HR | Dose of rescue drugs used to control blood pressure and HR will be checked | through study completion, an average of 1 year | 
| Postoperative pain: numeric rating scale | Postoperative pain will be evaluated using a numeric rating scale (0 being no pain, 10 being worst pain imaginable) | 30 minutes later operation |