Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Comment on Br J Anaesth 2023; 130: 786-794.

Editor—We read with great interest the randomised controlled trial comparing serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair. 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 (Advance Access published on Apr 11): 786-794https://doi.org/10.1016/j.bja.2023.02.038 Abstract Full Text Full Text PDF Scopus (0) Google Scholar Performing such a large trial is very laborious and the authors are to be complimented for their scientific thoroughness. The literature on fascial plane blocks is cluttered with case series, retrospective data, and inadequately performed research. 2 Haskins S.C. Memtsoudis S.G. Fascial plane blocks for cardiac surgery: new frontiers in analgesia and nomenclature. Anesth Analg. 2020; 31: 125-126 Crossref Scopus (5) Google Scholar ,3 Tran D.Q. Boezaart A.P. Neal J.M. Fascial plane blocks: the next leap. Reg Anesth Pain Med. 2021; 46: 568-569 Crossref PubMed Scopus (2) Google Scholar We are therefore delighted to see a well-conducted trial contradicting the increasingly popular beliefs that fascial plane blocks should always be added to a standard multimodal analgesia protocol in cardiac surgery. 4 Jack J.M. McLellan E. Versyck B. Englesakis M.F. Chin K.J. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia. 2020; 75: 1372-1385 Crossref PubMed Scopus (31) Google Scholar , 5 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 (1) Google Scholar , 6 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 (1) Google Scholar As most single-shot fascial plane blocks offer analgesic effects (if at all) only for up to 6 h (and very optimistically 12 h), 7 Kim D.H. Kim S.J. Liu J. Beathe J. Memtsoudis S.G. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med. 2021; 46: 600-617 Crossref Scopus (12) Google Scholar the attempt to prolong the analgesic effects by using liposomal bupivacaine as an alternative to catheter placement is potentially interesting. 8 Kelava M. Alfirevic A. Bustamante S. Hargrave J. Marciniak D. Regional anesthesia in cardiac surgery: an overview of fascial plane chest wall blocks. Anesth Analg. 2020; 131: 127-135 Crossref PubMed Scopus (71) Google Scholar