Use of Serratus Plane Block for Repair of Coarctation of Aorta: A Report of 3 Cases

Objectives The practice of regional anesthesia techniques (thoracic, epidural, paravertebral) in pediatric cardiac surgery enhances perioperative outcomes such as improved perioperative analgesia, decreased stress response, early extubation, and shortened hospital stay. However, these blocks can be technically challenging and can be associated with unacceptable failure rate and complications in infants. For these reasons, regional anesthesia is sometimes avoided in pediatric cardiac surgery. We describe the simple and effective serratus plane block for thoracotomy analgesia in 2 neonates and a child. Case Report We present 3 pediatric patients, each of whom was having coarctation repair and received an ultrasound-guided serratus plane block for thoracotomy analgesia. The patients were 3 days, 14 days, and 4 years old, weighing from 1.9 to 16 kg. The serratus plane block was performed prior to surgical incision. The block was technically simple compared with thoracic epidural or paravertebral block. All patients were extubated immediately after completion of surgery. Apart from the induction dose of fentanyl (2 μg/kg), no further opioids were required intraoperatively. Postoperative opioid requirements as well as duration of intensive care and hospital stay were lower than recent averages (for the same demographic and procedure) in our hospital. Conclusions We propose that the serratus plane block is a simple procedure that provides good perioperative analgesia for infant thoracotomy, potentially facilitating early extubation and a shorter hospital stay. Accepted for publication January 15, 2018. Address correspondence to: Abhijit Biswas, MBBS, MSc, FCARCSI, EDRA, Department of Anesthesia and Perioperative Medicine, London Health Science Centre, 339 Windermere Rd, London, Ontario, Canada N6A 5A5 (e-mail: avijitbsws@yahoo.com). This work is attributed to the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. Funding was provided by the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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