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Amitabh Gulati - One of the best experts on this subject based on the ideXlab platform.
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ultrasound guided Serratus plane block for treatment of postmastectomy pain syndromes in breast cancer patients a case series
Pain Practice, 2017Co-Authors: Jennifer Zocca, Grant H Chen, Vinay Puttanniah, Joseph C Hung, Amitabh GulatiAbstract:Postmastectomy pain syndrome is common after surgical treatment for breast cancer and may be challenging to manage. Currently, there are a wide variety of approaches to treat this type of pain, including medications, physical therapy, and interventional procedures. However, because of the complexity of innervation of the breast, the Serratus plane block may better target the web of nerves innervating the anterior chest wall including the breast. We present a case series of 8 patients who were successfully treated with Serratus plane block for pain after treatment for breast cancer. We feel that this particular application for the Serratus plane block deserves further investigation, as it is relatively easy to perform and has good clinical utility for this type of pain.
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“A Tale of Two Planes”: Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome
Regional anesthesia and pain medicine, 2017Co-Authors: Mohammad M. Piracha, Vinay Puttanniah, Stephen L. Thorp, Amitabh GulatiAbstract:Introduction Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of Serratus anterior plane blocks has been described in this population. We describe the addition of the deep Serratus anterior plane block (DSPB) for PMPS. Methods Four patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients9 outcomes was obtained through postprocedure interviews. Results Three of the patients previously had a superficial Serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial Serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB. Conclusions We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial Serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.
Gary L. Soderberg - One of the best experts on this subject based on the ideXlab platform.
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normalization procedures using maximum voluntary isometric contractions for the Serratus anterior and trapezius muscles during surface emg analysis
Journal of Electromyography and Kinesiology, 2005Co-Authors: Richard A. Ekstrom, Gary L. Soderberg, Robert DonatelliAbstract:The Serratus anterior and trapezius muscles are considered to be the only upward rotators of the scapula and are very important for normal shoulder function. A variety of methods have been used to produce a maximum voluntary isometric contraction (MVIC) of these muscles for normalization of EMG data. The purpose of this study was to quantify the surface EMG activity of the Serratus anterior muscle and the upper, middle, and lower parts of the trapezius during 9 manual muscle tests performed with maximum effort in 30 subjects. It was found that no one muscle test produced a MVIC for all individuals. Therefore, to perform normalization within each subject, it is suggested that the 2 or 3 tests identified in this study that produce high levels of EMG activity for each muscle be performed. The scapular protraction muscle test that is often used to normalize data for the Serratus anterior muscle produced relatively low levels of EMG activity and was not found to be an optimal test. Muscle tests in which an attempt was made to de-rotate the scapula from an upwardly rotated position produced much higher levels of EMG activity in the Serratus anterior muscle.
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Surface electromyographic analysis of exercises for the trapezius and Serratus anterior muscles.
The Journal of orthopaedic and sports physical therapy, 2003Co-Authors: Richard A. Ekstrom, Robert Donatelli, Gary L. SoderbergAbstract:Study Design This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and Serratus anterior muscles. Objective To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and Serratus anterior muscles. Background The trapezius and Serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises. Methods and Measures Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and Serratus anterior muscles during 10 exercises in 30 healthy subjects. Results The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapeziu...
Daniel I Sessler - One of the best experts on this subject based on the ideXlab platform.
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acute pain after Serratus anterior plane or thoracic paravertebral blocks for video assisted thoracoscopic surgery a randomised trial
European Journal of Anaesthesiology, 2020Co-Authors: Yuwei Qiu, Qi Huang, Dongsheng Yang, Ilker Ince, Daniel I SesslerAbstract:Background Serratus anterior and paravertebral blocks can both be used for video-assisted thoracic surgery. However, Serratus anterior blocks are easier to perform, and possibly safer. We therefore tested the primary hypothesis that Serratus anterior plane blocks and thoracic paravertebral blocks provide comparable analgesia for video-assisted thoracic surgery. Secondarily, we tested the hypothesis that both blocks lengthen the time to onset of surgical pain and reduce the need for rescue tramadol. Methods Patients having video-assisted thoracic lobectomy or segmentectomy were randomly allocated to ultrasound-guided thoracic paravertebral blocks, n = 30; ultrasound-guided Serratus anterior plane blocks, n = 30; or, general anaesthesia alone, n = 30. Visual analogue pain scores analogue pain scores at rest, during coughing and Prince-Henry pain scores were used to assess postoperative analgesia. Our primary analysis was noninferiority of Serratus anterior blocks compared with paravertebral blocks. Results Baseline characteristics were comparable among the three groups. Two hours after surgery, the mean difference in visual analogue pain scores between the Serratus anterior and paravertebral blocks was 0.0 (96.8% CI -0.4 to 0.3) cm at rest, -0.2 (-0.8 to 0.4) cm during coughing and -0.1(-0.5 to 0.3) for Prince-Henry pain scores. After 24 h, the mean difference was 0.0 (-0.7 to 0.8) cm at rest, 0.1 (-0.8 to 0.9) cm during coughing and 0.1(-0.4 to 0.6) for Prince-Henry pain scores. All differences were significantly noninferior. Time to onset of pain after surgery was 19 ± 5 (SD) hours with Serratus anterior blocks, 16 ± 5 h with paravertebral blocks and 12 ± 5 h with general anaesthesia. Anaesthesia with either block was associated with significantly less intra-operative propofol and sufentanil, reduced postoperative rescue analgesia (tramadol) and less postoperative nausea and vomiting compared with general anaesthesia alone. Patients with Serratus anterior block had a significantly lower incidence of intra-operative hypotension and requirement for intra-operative vasopressor (3.4%), compared with general anaesthesia alone. Serratus anterior block took less time to perform than paravertebral block (5.1 ± 1.1 min versus 10.1 ± 2.9 min). Conclusion Serratus anterior plane blocks, which are easier and quicker than paravertebral blocks, provide comparable analgesia in patients having video-assisted thoracic surgery. Clinical trial number and registry url ChiCTR1800017671; http://www.chictr.org.cn/hvshowproject.aspx?id=13510.
Faraj W Abdallah - One of the best experts on this subject based on the ideXlab platform.
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quality of recovery scores in deep Serratus anterior plane block vs sham block in ambulatory breast cancer surgery a randomised controlled trial
Anaesthesia, 2021Co-Authors: Faraj W Abdallah, Tulin Cil, Caveh Madjdpour, V Patel, Richard BrullAbstract:Deep Serratus anterior plane block has been widely adopted as an analgesic adjunct for patients undergoing breast surgery, but robust supporting evidence of efficacy is lacking. We randomly allocated 40 patients undergoing simple or partial mastectomy with sentinel node biopsy to receive either a pre-operative deep Serratus anterior plane block (Serratus group) or a placebo injection (sham group), in addition to systemic analgesia. The primary outcome measure was the quality of recovery score at discharge, as assessed by the quality of recovery-15 questionnaire at various time-points. Secondary analgesic outcomes included: pain severity; postoperative opioid consumption; opioid-related side-effects; patient satisfaction up to 7 days postoperatively; and persistent postoperative pain up to 3 months after surgery. All patients who were recruited completed the study. There were no differences in the quality of recovery-15 scores between patients in the Serratus and control groups, with mean (SD) scores of 96 (14) and 102 (20) for the control and Serratus groups, respectively. We were also unable to detect differences in any of the secondary analgesic outcomes examined. The addition of a deep Serratus anterior plane block to systemic analgesia does not enhance quality of recovery in patients undergoing ambulatory breast cancer surgery.
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too deep or not too deep a propensity matched comparison of the analgesic effects of a superficial versus deep Serratus fascial plane block for ambulatory breast cancer surgery
Regional Anesthesia and Pain Medicine, 2018Co-Authors: Faraj W Abdallah, Tulin Cil, David Maclean, Caveh Madjdpour, Jaime Escallon, John W SempleAbstract:Background and Objectives Serratus fascial plane block can reduce pain following breast surgery, but the question of whether to inject the local anesthetic superficial or deep to the Serratus muscle has not been answered. This cohort study compares the analgesic benefits of superficial versus deep Serratus plane blocks in ambulatory breast cancer surgery patients at Women9s College Hospital between February 2014 and December 2016. We tested the joint hypothesis that deep Serratus block is noninferior to superficial Serratus block for postoperative in-hospital (pre-discharge) opioid consumption and pain severity. Methods One hundred sixty-six patients were propensity matched among 2 groups (83/group): superficial and deep Serratus blocks. The cohort was used to evaluate the effect of blocks on postoperative oral morphine equivalent consumption and area under the curve for rest pain scores. We considered deep Serratus block to be noninferior to superficial Serratus block if it were noninferior for both outcomes, within 15 mg morphine and 4 cm·h units margins. Other outcomes included intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and incidence of postoperative nausea and vomiting. Results Deep Serratus block was associated with postoperative morphine consumption and pain scores area under the curve that were noninferior to those of the superficial Serratus block. Intraoperative fentanyl requirements, time to first analgesic request, recovery room stay, and postoperative nausea and vomiting were not different between blocks. Conclusions The postoperative in-hospital analgesia associated with deep Serratus block is as effective (within an acceptable margin) as superficial Serratus block following ambulatory breast cancer surgery. These new findings are important to inform both current clinical practices and future prospective studies.
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pectoralis and Serratus fascial plane blocks each provide early analgesic benefits following ambulatory breast cancer surgery a retrospective propensity matched cohort study
Anesthesia & Analgesia, 2017Co-Authors: Faraj W Abdallah, Tulin Cil, David Maclean, Caveh Madjdpour, Anuj Bhatia, Richard BrullAbstract:BACKGROUND:Pectoralis and Serratus blocks have been described recently for use in breast surgery, but evidence supporting their analgesic benefits is limited. This cohort study evaluates the benefits of adding a pectoralis or Serratus block to conventional opioid-based analgesia (control) in patient
Richard A. Ekstrom - One of the best experts on this subject based on the ideXlab platform.
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normalization procedures using maximum voluntary isometric contractions for the Serratus anterior and trapezius muscles during surface emg analysis
Journal of Electromyography and Kinesiology, 2005Co-Authors: Richard A. Ekstrom, Gary L. Soderberg, Robert DonatelliAbstract:The Serratus anterior and trapezius muscles are considered to be the only upward rotators of the scapula and are very important for normal shoulder function. A variety of methods have been used to produce a maximum voluntary isometric contraction (MVIC) of these muscles for normalization of EMG data. The purpose of this study was to quantify the surface EMG activity of the Serratus anterior muscle and the upper, middle, and lower parts of the trapezius during 9 manual muscle tests performed with maximum effort in 30 subjects. It was found that no one muscle test produced a MVIC for all individuals. Therefore, to perform normalization within each subject, it is suggested that the 2 or 3 tests identified in this study that produce high levels of EMG activity for each muscle be performed. The scapular protraction muscle test that is often used to normalize data for the Serratus anterior muscle produced relatively low levels of EMG activity and was not found to be an optimal test. Muscle tests in which an attempt was made to de-rotate the scapula from an upwardly rotated position produced much higher levels of EMG activity in the Serratus anterior muscle.
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Surface electromyographic analysis of exercises for the trapezius and Serratus anterior muscles.
The Journal of orthopaedic and sports physical therapy, 2003Co-Authors: Richard A. Ekstrom, Robert Donatelli, Gary L. SoderbergAbstract:Study Design This study used a prospective, single-group repeated-measures design to analyze differences between the electromyographic (EMG) amplitudes produced by exercises for the trapezius and Serratus anterior muscles. Objective To identify high-intensity exercises that elicit the greatest level of EMG activity in the trapezius and Serratus anterior muscles. Background The trapezius and Serratus anterior muscles are considered to be the only upward rotators of the scapula and are important for normal shoulder function. Electromyographic studies have been performed for these muscles during active and low-intensity exercises, but they have not been analyzed during high intensity exercises. Methods and Measures Surface electrodes recorded EMG activity of the upper, middle, and lower trapezius and Serratus anterior muscles during 10 exercises in 30 healthy subjects. Results The unilateral shoulder shrug exercise was found to produce the greatest EMG activity in the upper trapezius. For the middle trapeziu...
