Abstract The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group):1. general anesthesia group (P group);2. combined general anesthesia and SSPB group (S group), and3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.

BACKGROUND:The analgesic effect of fascia iliaca compartment block (FICB) versus no block (NB) after lower limb surgery (LLS) is still controversial, so we performed this meta-analysis.MATERIALS AND METHODS:By searching the PubMed, Embase and the Cochrane Library (last update by July 20, 2017), randomized controlled trials comparing the analgesic effect of FICB versus NB in patients receiving LLS were identified. The primary outcome was the pain scores at 4, 12, and 24 h after LLS. The dosage of morphine at 24 h was also collected. The side effect of anesthesia was assessed according to the occurrence rate of postoperative nausea and vomiting.RESULTS:Data from 7 clinical trials that included 508 patients were summarized. The results showed that patients receiving FICB had lower pain scores at 4 h (mean difference [MD]=-1.17; 95% CI=-2.30 to -0.05; P=0.041), 12 h (MD=-0.41; 95% CI=-0.76 to -0.05; P=0.026) and 24 h (MD=-0.96; 95% CI=-1.77 to -0.15; P=0.020) after LLS. Besides, FICB could reduce the dosage of morphine at 24 h (MD=-2.06; 95% CI=-3.82 to -0.30; P=0.022) and the incidence of postoperative nausea and vomiting (relative risk rate=0.44, 95% CI=0.24-0.80, P=0.008).CONCLUSION:Compared with NB, FICB is an effective and safe method for alleviating the pain after LLS. More high-quality randomized controlled trials are needed to confirm this finding.

Purpose: Postoperative cognitive dysfunction (POCD) occurs frequently in elderly people especially for those after major surgeries. Arthroplasty improves quality of life in elderly patients but is associated with high incidence of POCD. The problem that whether the different anesthesia methods have effects on POCD has long been a controversy. The objective of this study was to observe whether combined general and regional anesthesia affected perioperative cognitive trajectory in elderly patients with arthroplasty. Methods: Ninety patients with knee and hip arthroplasty aged between 60 yr and 79 yr were randomly allocated to general anesthesia group or combined general and regional anesthesia groups. Mini-mental state examination (MMSE) was performed to assess cognitive function changes before and at one week after surgery. Results: The postoperative MMSE was significantly higher in the combined anesthesia group than in the general anesthesia group (p=0.005). The postoperative MMSE score was significantly improved compared with preoperative MMSE score in both groups (p < 0.05). Conclusions: Our study demonstrated that combined general and regional anesthesia protected perioperative cognitive trajectory, providing evidence supporting use of regional anesthesia along with general anesthesia in elderly orthopedic patients who are vulnerable to postoperative cognitive decline.