Open thoracotomy is commonly considered to be one of the most agonizing surgical
operations. Pain following thoracotomy greatly impedes patient recovery and postoperative
respiration. The pain experienced after a thoracotomy can originate from various factors,
including the surgical incision, injury to the ribs and intercostal nerves, manipulation
of the pleura and lung tissue, and the placement of a drainage tube.Recent advances in
regional anesthesia techniques have aimed to provide more targeted and effective pain
relief. Among these, ultrasound-guided fascial plane blocks, such as the rhomboid
intercostal sub-serratus plane (RISS) block and the serratus anterior plane (SAP) block,
have emerged as promising options. Both blocks target the thoracic nerves, but they
differ in their anatomical approach and potential analgesic effects Postoperative pain
was not only related to a comfortable recovery but also related to postoperative
complications including pulmonary dysfunction, so the management of postoperative pain is
an important part of the care of post operation.
Regional anesthesia techniques have been shown to have a good effect on postoperative
analgesia and helps patients gain early recovery after operation.
Serratus anterior plane block (SAPB) is an easy, and safe method used for blockade of the
sensory plane of the lateral cutaneous branch of the intercostal nerve (T2-T9).
The Serratus anterior plane block targets the lateral cutaneous branches of the thoracic
intercostal nerves, which arise from the anterior rami of the thoracic spinal nerves and
run in a neurovascular bundle immediately inferior to each rib. At the midaxillary line,
the lateral cutaneous branches of the thoracic intercostal nerve traverse through the
internal intercostal, external intercostal, and serratus anterior muscles innervating the
musculature of the lateral thorax. These branches of the intercostal nerves travel
through the two potential spaces described above.
The "Rhomboid intercostal and sub serratus plane block" (RISS) is a relatively newer
block technique whose efficacy was documented in patients undergoing thoracic surgeries.
The RISS plane block involves the injection of local anesthetics into fascial planes,
theoretically allowing for catheter placement to achieve continuous analgesia. Successful
RISS plane blocks have been reported in various procedures, including lung
transplantation, radical mastectomy, and nephrectomy, strongly suggesting favorable
outcomes in postoperative pain relief.
In 2016, Elsharkawy et al. introduced a RA technique known as the rhomboid intercostal
block (RIB). Rhomboid intercostal block involves injecting a local anesthetic into the
upper intercostal muscle plane beneath the rhomboid muscles, providing analgesia to both
the anterior and posterior thorax.Based on past studies, investigators found that RISS
and SAPB are effectively decrease total opioid consumption, so investigators hypothesized
one of them is the best.
Statistical analysis:
Statistical analysis will be conducted using IBM SPSS Statistics 22(IBM Corp., Armonk,
NY, USA). The normal distribution of data will be assessed by the Kolmogorov-Smirnov and
Shapiro-Wilk tests. Mean and standard deviation will be used as descriptive statistics
for normally distributed numerical variables, while median and interquartile range (25th
to 75th percentiles) will be used as descriptive statistics for non-normally distributed
numerical variables. In addition, Chi-square test or fisher exact test will be employed
to test the significance between categorical variables as appropriate. Independent t test
will be employed for numerical data that exhibited normal distribution, whereas the
Mann-Whitney test will be used for numerical data that did not adhere to normal
distribution. A significance level of p < 0.05 will be deemed to be statistically
significant.