Combination of Ultrasound-Guided Serratus Anterior Plane Block and Rectus Sheath Block Provide Analgesia for Open Hepatectomy: A Report on 3 Cases

Siyou Tan¹, Wenyan Chen¹, Yongping Liu¹ and Lai Wei^1,

¹Department of Anesthesiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China

Cite this paper

Siyou Tan, Wenyan Chen, Yongping Liu and Lai Wei. Combination of Ultrasound-Guided Serratus Anterior Plane Block and Rectus Sheath Block Provide Analgesia for Open Hepatectomy: A Report on 3 Cases. American Journal of Medical Case Reports. 2022; 10(3):68-71. doi: 10.12691/AJMCR-10-3-7

Abstract

Perioperative analgesia in open hepatectomy is challenging because a large subcostal arc incision is often required. Extensive dissection of muscles and nerves is associated with severe intraoperative hemodynamic fluctuations and postoperative pain. Serratus anterior plane block (SAPB) and rectus sheath block (RSB) are commonly used for anesthesia and postoperative analgesia in patients undergoing chest wall surgery and abdominal surgery, respectively. In this case-series report, we present our experience with three patients in whom open hepatectomy and early extubation were performed successfully under a combination of ultrasound-Guided SAPB and RSB. Three patients were scheduled for open hepatectomy, all of them were diagnosed with severe hepatitis B cirrhosis. After due deliberation and with the consent of patients and their family, ultrasound-guided right SAPB and bilateral RSB were performed with the patient in the supine position. A total of 0.7mL/kg of 0.25% ropivacaine was used for nerve block. Sensory loss to pinprick from T5 to T10 was achieved in all three patients 20 min after administration of blocks. The operation went smoothly for all the patients. All three patients experienced quiet recovery and early extubation, and none of them complained of discomfort in the surgical site in the first 12 h after surgery. Here we present three cases of a combination of ultrasound-guided SAPB and RSB that may be an attractive option for anesthetic management of open hepatectomy in clinical practice.

Keywords

serratus anterior plane block, rectus sheath block, analgesia, hepatectomy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Fujio A, Miyagi S, Tokodai K, et al. Effects of a new perioperative enhanced recovery after surgery protocol in hepatectomy for hepatocellular carcinoma [J]. Surg Today, 2019.
[2]	Biswas A, Castanov V, Li Z, et al. Serratus Plane Block: A Cadaveric Study to Evaluate Optimal Injectate Spread [J]. Reg Anesth Pain Med, 2018, 43(8): 854-858.
[3]	Landmann A, Visoiu M, Malek MM. Development of a novel technique for bilateral rectus sheath nerve blocks under laparoscopic-guidance [J]. J Pediatr Surg, 2017, 52(6): 966-969.
[4]	Okmen K, Metin Okmen B. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery [J]. Anaesth Crit Care Pain Med, 2018, 37(4): 349-353.
[5]	Jeong HW, Kim CS, Choi KT, et al. Preoperative versus Postoperative Rectus Sheath Block for Acute Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomized Controlled Study [J]. J Clin Med, 2019, 8(7).
[6]	Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block [J]. Anaesthesia, 2013, 68(11): 1107-13.
[7]	Elsharkawy H, Maniker R, Bolash R, et al. Rhomboid Intercostal and Subserratus Plane Block: A Cadaveric and Clinical Evaluation [J]. Reg Anesth Pain Med, 2018, 43(7): 745-751.