Thoracotomy is one of the most painful surgical operations known. Pain after thoracotomy
significantly affects pulmonary function. Factors that cause this pain include cutting
and stretching of the ribs, rupture or stretching of the fibrous attachments of the ribs
to the vertebral body anteriorly and to the sternal cartilage posteriorly, and cutting of
the chest wall muscles. Complications caused by pain include inability to cough due to
decreased respiratory movements and inability to expel bronchial secretions, atelectasis,
pneumonia, bronchitis, hypoxemia, respiratory failure and prolonged mechanical
ventilation.
Effective relief of postoperative pain in patients undergoing thoracic surgery
accelerates recovery and reduces the rate of postoperative complications. Thus, the
negative effects of postoperative pain can be prevented and early mobilization and
shortening of hospital stay can be achieved. Currently, multimodal approaches are used
for postoperative analgesia.
Regional anesthesia modalities are often combined with paracetamol, nonsteroidal
anti-inflammatory drugs (NSAIDs) and opioids. Ultrasonography (USG)-guided nerve blocks
are less invasive and easier to administer than thoracic epidural analgesia and
paravertebral blocks for thoracic surgery analgesia. They can be used alone or as part of
multimodal analgesia. Pectoral nerve block (PECS), erector spina block (ESPB),
transversus abdominis plan (TAP) block and serratus anterior plan block (SAPB), which can
also be applied in operations related to the chest wall, are some of them.
SAPB, which can provide analgesia between the second thoracic vertebra (T2) and ninth
thoracic vertebra (T9) levels, is one of the plan blocks that can be applied with USG. It
has been reported that the application of local anesthetic drugs to the area between the
serratus anterior muscle and intercostal muscle in the T2-T9 dermatomes can block the
cutaneous branches of the intercostal muscles. It has been found that approximately 12
hours of sensory block can be obtained with SAPB, which can be used in operations related
to the chest wall other than thoracic surgery.
Erector spina plan block is a popular fascial plan block in recent years and has been
reported to provide effective analgesia in thoracic pain. It has been successfully used
in the treatment of pain after both thoracic and abdominal surgery and in the management
of chronic thoracic pain. ESPB has the ability to provide analgesia to both anterior and
posterior hemithorax, which is particularly effective in pain management after extensive
thoracic surgery or trauma (anterior, posterior and lateral chest wall).
Thoracic epidural analgesia is considered the gold standard in the treatment of
postoperative pain in thoracic surgery. Considering the invasiveness of TEA, complication
rates and application difficulties, alternative methods are needed. At this point,
USG-guided ESPB is preferred as an alternative to TEA. However, the fact that ESPB
applied after thoracic surgery is insufficient to relieve pain, especially in the chest
drain region, raises questions. The main aim of our study is to investigate the
hypothesis that the combination of ESPB and SAPB provides more effective analgesic
efficacy compared to ESPB alone by relieving pain in the chest drain area in addition to
chest wall analgesia after thoracic surgery.