US-Guided Serratus Anterior Plane Block Versus Thoracic Epidural in Patients Undergoing Thoracotomy

in lateral position a linear transducer (10-12MHz, M-Turbo) will be used, The 5th rib is identified in the mid-axillary line. The following muscles are overlying the rib latissimusdorsi ,teres major, and serratus muscle.The needle (22G, 50-mm Tuohy needle) is introduced in-plane targeting the plane superficial to serratus muscle. local anesthetic is injected then a catheter is threaded and . Ultrasound-guided SAPB was done using a serratus anterior catheter Group DL (n=20) received a bolus of 30 mL of 0.25% bupivacaine followed by a continuous infusion of 0.125% bupivacaine at a rate of 7-12 ml/hr according to patient response upon ICU arrival after the stabilization of the clinical status. The infusion was continued until the end of the 1st 24 hours postoperatively .

A thoracic epidural catheter was done to the patient while sitting. Tuohy needles are used. Epidural space can be identified by loss of resistance. Injection begins with a negative aspiration and a test dose (3 ccs of 1.5% lidocaine with 1:200,000 epinephrine) .A Continuous epidural technique through the placement of a catheter 3-5 cm beyond the needle is applied. Injection in 5ml increments of 0.25% bupivacaine is used until the block of the required segments achieved ( 10 to 15ml). sensory testing is via pinprick and cold test to detect sympathetic block . Throughout the technique hourly injection of 5 ml 0.25% bupivacaine for maintenance.

bupivacaine

3 ccs of 1.5% lidocaine with 1:200,000 epinephrine