Ultrasound-Guided Erector Rhomboid Intercostal and Subserratus Plane Block (RISS) for perioperative analgesia in patients undergoing thoracotomy: a prospective randomized controlled study

Abstract

Background: The surgery of open thoracotomy often causes severe pain. The pain following thoracotomy affects respiration and rehabilitation.

Objectives: was to test ultrasound-guided rhomboid intercostal and subserratus plane (RISS) block for preoperative analgesia in open thoracotomy patients.

Design: a prospective randomized controlled study.

Setting: Tanta University Hospitals. Methods: 60 ASA I-III patients aged 18-60 and of any gender scheduled for elective unilateral open thoracotomy were randomly divided into two groups. The RISS group had a 10 ml ultrasound-guided bupivacaine 0.25% injection in the rhomboid intercostal region on the same side. Additionally, they received a 20 ml subserratus plane injection of 1:200 000 epinephrine. Control group received only general anesthesia. The initial 24-hour postoperative VAS score was the main outcome measure. Fentanyl during surgery, total morphine provided in 24 hours after surgery, and initial morphine dose were secondary outcomes.

Results: The RISS block group had significantly lower Visual Analog Scale scores in the first 12 hours after surgery (P < 0.001). The control group consumed more fentanyl (73.5 [35.75 – 88.5] μg) during surgery compared to the RISS block group (0.0 [0.0 – 34] μg) (P = 0.001). RISS block group morphine consumption was significantly lower than control group (21.0 [18.0–24.25] mg) over a 24-hour period (P = 0.001). The RISS group took longer to get the initial morphine dose than the control group (P < 0.001, 95% CI (605.0-855.0)).

Conclusion: Open thoracotomy patients who got an ultrasound-guided regional intercostal subcostal block had lower VAS scores for 12 hours after surgery.

Pan African Clinical Trials Registry: (PACTR202008534389448)