Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Comment on Br J Anaesth 2023; 130: 786–94

Editor—In a single-centre randomised controlled trial including 194 patients who underwent robotically assisted mitral valve repair, Alfirevic and colleagues 1 Alfirevic A. Marciniak D. Duncan A.E. et al. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Br J Anaesth. 2023; 130: 786-794 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar showed that combined pectoralis II and serratus anterior plane blocks did not improve postoperative analgesia assessed by overall benefit analgesia score (OBAS) and respiratory mechanics, and did not decrease cumulative opioid consumption during the initial three postoperative days. Their results are in accord with the findings of two recent studies of patients undergoing minimally invasive mitral valve surgery and coronary artery bypass surgery. 2 Hoogma D.F. Van den Eynde R. Al Tmimi L. et al. Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: results of a double-blind, prospective randomized placebo-controlled trial. J Clin Anesth. 2023; 86111072 Crossref PubMed Scopus (12) Google Scholar ,3 Hoogma D.F. Van den Eynde R. Oosterlinck W. et al. Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: results of a randomized placebo-controlled trial. J Clin Anesth. 2023; 87111088 Crossref PubMed Scopus (13) Google Scholar However, we had several questions regarding design and results of this study. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trialBritish Journal of AnaesthesiaVol. 130Issue 6PreviewMinimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics. Full-Text PDF Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair. Response to Br J Anaesth 2023; 131:e126-7British Journal of AnaesthesiaVol. 131Issue 5PreviewEditor—In their comment on our paper,1 Xue and colleagues2 assert that the Overall Benefit of Analgesia Score (OBAS) lacks validation for minimally invasive cardiothoracic operations. However, there is nothing procedure-specific in the OBAS score, which is a general measure of opioid effect. It has been validated for numerous procedures and nothing in the scoring system suggests that it needs specific validation for each type of surgery.3 Consequently, the OBAS has been used as an outcome measure for video-assisted thoracoscopic surgery, which is similar to the approach used in our patients. Full-Text PDF