A comparison of the analgesic efficacy of serratus anterior plane block vs. paravertebral nerve block for video-assisted thoracic surgery: a randomized controlled trial

Yi Zhang, Ze Fu, Te Fang, Kexin Wang, Zimeng Liu, Hongqing Li, Wenwen Jiang, Xuezhao Cao, Yi Zhang, Ze Fu, Te Fang, Kexin Wang, Zimeng Liu, Hongqing Li, Wenwen Jiang, Xuezhao Cao

Abstract

Introduction: Patients who undergo video-assisted thoracic surgery (VATS) frequently experience moderate to severe postoperative pain. Serratus anterior plane block (SAPB) is a relatively novel technique that can block the lateral cutaneous branches of the intercostal nerves as well as the long thoracic nerve.

Aim: To evaluate the analgesic efficiency of deep serratus plane block (DSPB) and superficial serratus anterior plane block (SSPB) as well as paravertebral nerve block (PVB) in patients undergoing VATS.

Material and methods: A total of 74 patients aged 16-80 undergoing VATS were randomized to receive either DSPB or SSPB as well as PVB. Ultrasound (US) guided DSPB or SSPB as well as PVB was performed preoperatively on the patients according to their groups. All patients were provided with patient-controlled intravenous analgesia (PCIA) for postoperative analgesia. The primary outcomes were the levels of postoperative pain at rest and on coughing evaluated by the visual analog scale (VAS), and intraoperative and postoperative opioid consumption. The secondary outcomes included PCIA pressing times, side effects and satisfaction with analgesia, duration of nerve block, intraoperative hemodynamic changes and vasoactive drug dosage.

Results: No significant differences of VAS score were found. During the operation, PVB reduced consumption of opioids (27.23 ±5.10 mg) compared to DSPB (31.20 ±3.80 mg) and SSPB (32.61 ±5.28 mg). The effective pressing times of PCIA in the SSPB group (0.18 ±0.65) were significantly lower compared to the PVB group (1.09 ±1.50) at 12 h postoperatively. Accordingly, SSPB also reduced the dosage of PCIA (26.55 ±4.72 ml) compared to PVB (31.45 ±7.60 ml). Time of the PVB procedure was longer (11.14 ±1.66 min) than DSPB (5.68 ±1.10 min) and SSPB (4.77 ±1.04 min).

Conclusions: DSPB and SSPB are easy to perform and can serve as a promising alternative technique to PVB that may offer comparable analgesic effectiveness for patients undergoing VATS.

Keywords: deep serratus plane block; paravertebral nerve block; postoperative pain; superficial serratus anterior plane block; video-assisted thoracic surgery.

Conflict of interest statement

The authors declare no conflict of interest.

Copyright: © 2021 Fundacja Videochirurgii.

Figures

Figure 1
Figure 1
Flow diagram of the study
Figure 2
Figure 2
Intraoperative MAP changes: A – OR admission, B – before operation, C – 5 min after operation, D – before extubation, E – 5 min after extubation, F – after leaving PACU
Figure 3
Figure 3
Intraoperative heart rate changes: A – OR admission, B – before operation, C – 5 min after operation, D – before extubation, E – 5 min after extubation, F – after leaving PACU

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Source: PubMed

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