Ultrasound Guided Blocks for Management of Postoperative Pain after Video-assisted Thoracic Surgery (VATS)

Intrododuction: Pain management after VATS can be achieved using different regional techniques. Epidural catheters are labor intensive, time consuming and are rarely required after the first 24 hours. Intervertebral nerve blocks performed under vision by the surgeon rarely proved analgesia beyond the first six hours. We describe here the use of two fascial plane blocks that when combined provide effective analgesia for up to 24 hours.

Methods: With the patient still in the latereal position, we identify the plane between the latissumis dorsi and serratus anterior muscle in the mid-axillary line at the level of T5 and inject 20 ml of marcaine 0.25%. We then identify the plane between the pectoralis major and minor muscles in the mid-clavicular line at the level of T3-4 and inject here another 20 ml of marcaine 025% (Pecs2 block).

Results: In the recovery room, the patients are treated per protocol including systemic narcotics if required. The big difference is seen after the patients go back to the surgical ward. We have now utilized this combined block in over 10 patients and none of them have required and further narcotics during the first posterperative day.

Discussion: Regioanl techniques all share the advantage of reducing the need for systemic narcotics after surgery. The use of a combined Pecs2 and LD-SA fascial plane block as described here is relatively simple to perform, is not time consuming and has proved to be extremely effective in reducing the use of narcotics during POD1 after VATS.