Intermittent 0.25% Bupivacaine Bolus Administered Through a Serratus Posterior Superior Intercostal Plane Catheter for Postoperative Analgesia Following Posterolateral Thoracotomy

Effective pain management after thoracotomy is crucial for faster recovery in pediatric patients. Various chest wall plane blocks have been used to achieve this [1]. Recently Tulgar et al. [2] described a serratus posterior superior intercostal plane block (SPSIPB). In this block local anesthetic was deposited between the serratus posterior superior muscle and intercostal muscles at the level of the 3rd rib. Here, we describe our experience using SPSIPB for postoperative pain control in an 8-year-old child who underwent thoracotomy for the excision of a germ cell tumor in the right hemithorax under general anesthesia. Written informed consent was taken from the parent. At the end of surgery, we administered the serratus posterior superior intercostal plane block in the lateral decubitus position. Block technique: A linear probe (M-Turbo, Fujifilm Sonosite Inc., Bothell, WA, USA) was kept medial to the medial border of the scapula (Figure 1). Identified the first rib, then the probe was moved downwards; we detected the third rib. After recognizing the trapezius, rhomboid major, and serratus posterior superior muscles (SPSm), the Tuohy needle was inserted in a caudal-to-cranial direction between the SPSm and intercostal muscle (Figure 1). 5 mL of saline was used for hydro-dissection, then an epidural catheter was inserted. When the catheter tip was confirmed after that we gave 15 mL of 0.25% bupivacaine. In the postoperative period we administered 15 mL of bupivacaine 0.25% every 6 h. Injection of paracetamol 15 mg/kg was given every 8 h. The postoperative period pain assessment was done using a NRS score at different time intervals (at 1 h, 3 h, 6 h, 12 h, and 24 h). The NRS score remained 3/10, 2/10, 3/10, 2/10, 2/10, and there was no requirement for rescue analgesia. No complications were observed, like pneumothorax, hematoma, or local anesthetic toxicity. After 72 h the catheter was removed. Tulgar et al. [2] found that serratus posterior superior plane blocks provide analgesia anterolateral hemithorax in dermatomes at the level of C3-T10 due to blockade of lateral cutaneous branches of spinal nerves. Yazar et al. [3] used SPSIPB in two pediatric patients. A 7-year-old undergoing discrete subaortic stenosis surgery and a 9-year-old undergoing Sprengel deformity correction they found that SPSIPB was a safe and effective application in pediatric patients. Akin et al. [4] used a continuous SPSIPB block for atrial mass excision via minithoracotomy. They reported the safety and efficacy of analgesia in the anterolateral posterior chest wall is due to sensory blockade between the C3 and T7/10 dermatomes. Ciftci et al. [5] performed SPSIPB on three patients undergoing breast surgery. They discovered dermatomes with analgesia that was sufficient, ranging from C3 to T10, based on dermatome analysis. The continuous serratus posterior intercostal plane block (SPSIPB) offers effective pain management with minimal complications in pediatric patients. The authors have nothing to report. Taken from the parent. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.