الفهرس 
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Abstract
Postoperative pain relief constitutes a major concern in modern anesthesia management. Thoracotomy is associated with severe postoperative pain which can lead to respiratory complications such as hypoventilation, hypoxemia, atelectasis, pulmonary infections, and ultimately respiratory failure. Inadequate postoperative pain control may also lead to postoperative thoracotomy pain syndrome that can persist for months to years.
Use of local anesthetics and regional techniques became an important component in the recent multimodal analgesia modalities. They provide the advantages of faster recovery, improved postoperative pain control, less need for opioids and decreased incidence of postoperative nausea &vomiting (PONV). For thoracic surgeries, they include thoracic epidural analgesia, paravertebral block, intercostal nerve blocks and interfascial techniques.
The erector spinae plane block (ESPB) is an ultrasound guided novel interfascial paraspinal plane technique that was initially used for patients with severe acute or chronic thoracic neuropathic pain. It is supposed to work at the origin of spinal nerves. This block serves the purpose of a paravertebral block without risk of pleural injury.
The serratus anterior plane block (SAPB) is another ultrasound guided block that was firstly described by Blanco et al in 2013. It provides analgesia to the anterolateral chest wall from T2 to T9 dermatomes through blocking the lateral cutaneous branches of thee thoracic intercostal nerves.
Ultrasound-guidance offers the advantage of real-time visualization of the anatomical structures, the needle movement, the placement of local anesthetic, and hence provides higher success rates of the block with fewer complications.
The primary aim of this work was to compare the analgesic effects of ultrasound guided ESPB with SAPB under general anesthesia for thoracotomy regarding first time to call analgesia postoperatively.
The secondary aims were to know the total amount of consumption of intraoperative fentanyl, effect of the blocks on intra- and postoperative hemodynamics, assessment of postoperative analgesia evaluated by Visual Analogue Pain Scale (VAS), total postoperative consumption of analgesics, and postoperative nausea and vomiting (PONV).
Thirty adult patients of both sexes, ASA I or II physical status, aged between 18 and 60 years old, scheduled for elective thoracotomy were randomly divided into two equal groups 15 patients each. group A had received ultrasound-guided ESPB with 20 ml bupivacaine 0.25% and group B had received ultrasound-guided SAPB with 20 ml bupivacaine 0.25%.
Both blocks were given after induction of general anesthesia. Time to first rescue analgesia, Total amount of Nalbuphine consumed during the first postoperative 24 hours, VAS, MAP and HR were recorded. Data were analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp).
Results showed that both ESBP and SAPB provided postoperative analgesia after thoracotomy but ESPB was going to be more effective than SAPB in prevention of post thoracotomy pain syndrome.
Time to first rescue analgesia was significantly longer in ESPB as it provided analgesia up to 8 hours postoperative, Total amount of Nalbuphine consumed during the first postoperative 24 hours, VAS, MAP and HR were significantly higher in SAPB. No major side effects occurred in both groups.