Serratus Anterior Plane Block: A Better Modality of Pain Control after Pectus Excavatum Repair.

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

Parallel Venovenous and Venoarterial Extracorporeal Membrane Oxygenation for Respiratory Failure and Cardiac Dysfunction in a Patient with Coronavirus Disease 2019: A Case Report.

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a lifesaving technique for patients experiencing respiratory failure. When VV ECMO fails to provide adequate support despite optimal settings, alternative strategies may be employed. One option is to add another venous cannula to increase venous drainage, while another is to insert an additional arterial return cannula to assist cardiac function. Alternatively, a separate ECMO circuit can be implemented to function in parallel with the existing circuit. We present a case in which the parallel ECMO method was used in a 63-year-old man with respiratory failure due to coronavirus disease 2019, combined with cardiac dysfunction. We installed an additional venoarterial ECMO circuit alongside the existing VV ECMO circuit and successfully weaned the patient from both types of ECMO. In this report, we share our experience and discuss this method.