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Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial

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  • Basic Science/Experimental
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Abstract

Purpose

Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method.

Methods

This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints.

Results

The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort.

Conclusion

The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia.

Level of Evidence II

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Acknowledgments

We would like to thank all the colleagues at Plastic Surgery Hospital who participated in this research and MJEditor (www.mjeditor.com) for their linguistic assistance during the preparation of this manuscript.

Funding

This study was supported by no funding.

Author information

Author notes

  1. Guihua Xiang and Chunmei Chen have contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China

    Guihua Xiang, Chunmei Chen, Keyu Chen, Quanle Liu & Dong Yang

  2. Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33, Ba Da Chu Road, Shi Jing Shan, Beijing, 100144, China

    Yan Huang, Lan Huang, Jing Jin & Jiantao Shang

  3. Department of Gynecology, Peking University Third Hospital, No. 49, Huayuan North Road, Haidian District, Beijing, 100144, China

    Xiaole Sun

Authors
  1. Guihua Xiang
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  2. Chunmei Chen
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Corresponding author

Correspondence to Dong Yang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

This study met ethical standards and was approved by the Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College (ZX2022-44). Written informed consent was obtained from the parents/guardian of all patients. The trial was registered in China Clinical Trial Registration Center (http://www.chictr.org.cn) before patient enrollment (ChiCTR2200058152.31/03/2022).

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Xiang, G., Chen, C., Chen, K. et al. Comparing the Analgesic Effects Between the Pre- and Post-costal Cartilage Harvest Cohorts Using Ultrasound-Guided Deep Serratus Anterior Plane Block in Children with Microtia Undergoing Auricular Reconstruction: A Randomized Clinical Trial. Aesth Plast Surg 48, 1846–1854 (2024). https://doi.org/10.1007/s00266-023-03836-8

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