Comments a recent paper about the Serratus plane block
The wonderful thing about medicine, and especially regional anaesthesia is the fact that it is always evolving. We are constantly challengeing the fronteers of our experience, knowledge and skills as evidenced by the number of publications that appear. Dr Blanco et als’ publication of the Serratus Plane Block, as I understand, has come about from a progression of the Pecs I and II blocks. What really impressed me about the publication is the use of imaging and reconstruction to visualise the spread of local anaesthetic to allow confirmation of the theory of the block. As regional anaesthetist, we are querious as to where our local anaesthetic has been deposited. Even with ultrasound guidance, we are not completely sure where our total volume has spread to. This is vital as this will ultimately affect our blocks with respect to onset, duration and potential complications both short and long term. Although limited to a small number of volunteers, the study is exciting as it provides real potential alternative for clinically effective, opiate sparing, post operative pain relief. Traditional methods of post op analgesia for breast surgery involved neuraxail and paravertebral methods that, although were clinically effective, carried a high risk for potential complications and unwanted side effects. Intercostal blocks need multiple injections and its duration of action limited. In the last ten years, another Plane block, the Transverse Abdominal Plane (TAP) block has been increasingly gaining popularity, especially in the last five years or so. This block has a number of advantages, which include technical simplicity, high analgesic effectiveness, opioid sparing, long duration of effect, minimal side effects in comparison to that associated with neuraxial analgesia (e.g., hypotension, motor blockade). However, its disadvantages are the need to perform a bilateral block for midline incisions and provision of somatic analgesia only without any effect on visceral pain. I liken the Serratus Plane Block to the TAP block. While the likelihood of needle placement misadventures may be minimized with the proper use of ultrasound guidance, the potential complications of motor block and the possibility of local anesthetic toxicity are possible. It seems to have a high margin of safety and is technically simple to perform, especially under ultrasound guidance. The body of evidence supporting the use of TAP blocks is growing; yet, widespread adoption of this therapeutic adjunct has been slow. In part, this may be related to the limited sources for anesthesiologists to develop an appreciation for its sound anatomical basis and the versatility of its clinical application. As the move towards day surgery is encouraged, we need to look for safe, effective alternatives to our classical practice that delivers high patient satisfaction.
Dr Beenu Madhavan. MBBS, BSc, FRCA, EDRA. Consultant Anaesthetist currently at University Hospital Lewisham, London, UK.
He had a keen interest in pain, especially pain following surgery, which led him to research into pain mechanism at UCL anatomy department during his intercalated BSc. He graduated in Medicine from University College London (UCL) in 1998 with an intercalated BSc. in Neuroscience.
During his medical career, he trained as a surgeon, but learned that anaesthetists were the experts in pain control and post operative analgesia, so he followed a structured training path as set by the Royal College of Anaesthetist to develop his chosen vocation.
He has undertaken a fellowship in regional anaesthesia at Guys and St Thomas’ Hospital & University Hospital Lewisham and has gained the European Diploma in Regional Anaesthesia.
He is currently the Vice Chair, and soon to be the Chairman of London Society of Regional Anaesthesia. He has, with the committee orgainsed and taught on a number of ultrasound guided regional anaesthesia courses in London. He has also been invited as international faulty on European sonoanatomy regional anaesthesia courses. He Undertakes a relaxed and practical approach to teaching.