US-Guided Serratus Anterior Plane Block Versus Thoracic Epidural in Patients Undergoing Thoracotomy

Thoracic surgeries is known to be one of the most painful surgeries . Multiple analgesic techniques have been used for post operative analgesia including Thoracic epidural , Patient Controlled Analgesia and systemic opioids. Opioids are associated with multiple sied effects including : PONV , Respiratory depression and ileus while thoracic epidural has its own complications such as hemodynamic instability , injury of spinal cord, pneumothorax and epidural hematoma.Peripheral nerve blocks provide good alternative for perioperative analgesia. The purpose of our study is to compare the effectiveness of perioperative continuous serratus anterior plane block versus continuous thoracic epidural in pain management during thoracic surgeries for malignancy resection.

Inclusion Criteria:Physical status ASA II and III.Body mass index (BMI): > 20 kg/m2 and < 40 kg/m2.A patient undergoing thoracotomy for cancer surgery (Lobectomy, Pneumonectomy, and Decortication).Exclusion Criteria:Patient refusalKnown sensitivity or contraindication to local anesthetics.History of psychological disorders.Localized infection at the site of block.Coagulopathies with a platelet count below 50,000 or an INR>1.5: hereditary (e.g. hemophilia, fibrinogen abnormalities & deficiency of factor II) - acquired (e.g. impaired liver functions with PC less than 60 %, vitamin K deficiency &therapeutic anticoagulants drugs),History of unexplained or easy bruising and Prolonged bleeding from small cuts or after dental procedures.patients need prolonged mechanical ventilation postoperatively excluded from our study.failed blocks will be excluded from our study