Rhomboid Intercostal and Serratus Anterior Interfascial Plane Blocks for the Treatment of Post-Operative Pain after Video-Assisted Thoracoscopic Surgery: A Retrospective Propensity-Matched Study.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) techniques are commonly used for surgical procedures within the thoracic cavity with smaller incisions. There are very few regional anesthesia methods used to achieve this goal. This study aimed to investigate the effect of two fascial plane block technique rhomboid intercostal block (RIB) and serratus anterior plane block (SAPB) administered on pain scores after VATS. METHODS: A total of 90 patients who underwent VATS were included in this study. Patients were divided in three groups: Group R (intravenous patient-controlled analgesia (IV. PCA) +RIB with (25 mL 0.25% bupivacaine; n=30), Group S (IV. PCA + SAPB with (25 mL 0.25% bupivacaine; n=30), and Group C (IV. PCA). The primary outcome was determined as a tramadol consumption amount (at hours 6, 12, and 24). Postoperative pain was evaluated using the VAS (at the 30th minute, 2nd, 6th, 12th, and 24th hours) scores. Secondary outcomes included the side effect profile and additional analgesic use. RESULTS: VAS scores of the Group R were found to be statistically significantly lower to those of Group S and Group C (p<0.05). A comparison of Groups R and S with Group C in terms of tramadol consumption amounts, at all measurement time points, revealed statistically significantly lower values (p<0.005). CONCLUSION: As per the results of this study, we believe that RIB and SAPB administration for pain palliation after VATS is an effective analgesia technique.

Pleurovenous shunt for treating refractory benign pleural effusion.

We report the case of a 63-year-old female with hepatic cirrhosis due to chronic hepatitis C, successfully treated for refractory nonmalignant hepatic hydrothorax by using a long-term pleurovenous shunt (PVS). After failure of conventional treatment by mechanical pleurodesis, a PVS was inserted to drain the pleural fluid into the right subclavian vein. After 8 months of follow-up, the effusion is well controlled, and the shunt remains patent.

[Thoracoscopic bullectomy and pleural abrasion in the treatment of primary spontaneous pneumothorax]. / Primer spontan pnömotoraks tedavisinde torakoskopik büllektomi ve plevral abrazyon.

Although spontaneous pneumothorax is the most common problem seen by the thoracic surgeon, there is no universal agreement in its management. Thoracoscopic bullectomy is preferred to open bullectomy because of minimal trauma, less pain, early recovery and discharge with comparable results. Seventy thoracoscopic bullectomy and apical pleural abrasion in 65 patients with spontaneous pneumothorax were retrospectively reviewed. All but 8 (13%) patients were male with a mean age of 24 years (range 17-55). Only the patients who had a prolonged air leak (> 4 days), reccurence/bilateral pneumothorax occupational reasons and bilateral pneumothorax were the indications for surgical treatment. The patients who had conversion to open thoracotomy were not included in the study. Computerized tomography was performed in all cases prior to the surgery. Endo-GIA 45-60 mm (4.8) staplers (Auto Suture, Tyco, USA) were used for bullectomy using three port access. The apical pleural abrasion following thoracoscopic bullectomy was performed in all cases. One patient developed haematoma on the first postoperative day and underwent open thoracotomy and evacuation of the haematoma. The median hospital stay was 3 (1-11) days. Recurrent pneumothorax was observed in 5 (7.1%) patients. Although thoracoscopic bullectomy is an expensive procedure that requires experience, however reduced pain, shorter hospital stay and early recovery makes it preferred method in such cases.