الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Pain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. A thoracotomy requires a very painful incision, involving multiple muscle layers, rib resection, and continuous motion as the patient breathes.
Treatment of acute post-thoracotomy pain is particularly important not only to keep the patient comfortable but also to minimize pulmonary complications. Many methods of pain management, each with attendant problems, have been tried with varied success, for example: intercostal nerve block, intrapleural analgesia, cryo-analgesia, lumbar epidural, thoracic epidural, paravertebral block, IV narcotics, intrathecal or epidural narcotics, NSAIDS and transcutaneous nerve stimulation. There are different analgesic modalities for management of post-thoracotomy pain. There are systemic methods which includes infusion and patient-controlled analgesia (PCA) or regional techniques that mainly rely on epidural, intrathecal or paravertebral blocks. Other techniques range from intercostal nerve block to cryoprobeneurolysis .
A recent ultrasound guided regional anesthetic block, the serratus anterior plane block(SAPB), targeting the plane above or below the serratus anterior muscle in the mid axillary line had been described. It was believed to provide analgesia to a hemithorax by blocking the lateral branches of the intercostal nerves .
The block is expected to avoid autonomic blockade associated with TEA as well as the risk of serious complications involving the pleura and central neuraxial structures.
Aim of the study: The aim of this study was to assess the safety and efficacy of SAPB compared to TEA for relieving acute thoracotomy pain.
Results: In this study, we found that, the recently described SAPB, while maintaining a stable blood pressure, it provided good analgesia comparable to that provided by TEA for acute post thoracotomy pain. Hypotension was more remarkable in those who had epidurals than those with SAP catheters. Morphine rescue analgesia as well as VAS pain scores during normal tidal breathing were similar in both study groups. Nausea and vomiting scores as well as oxygen saturations were comparable in all patients during the study period.
Conclusion: We recommend that Serratus anterior plane block appears to be a safe and effective alternative for postoperative analgesia after thoracotomy.