eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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1/2022
vol. 17
 
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Anaesthesiology
abstract:
Randomized controlled trial

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
1
,
Ze Fu
1
,
Te Fang
1
,
Kexin Wang
1
,
Zimeng Liu
1
,
Hongqing Li
1
,
Wenwen Jiang
1
,
Xuezhao Cao
1

  1. Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, Liaoning, China
Videosurgery Miniinv 2022; 17 (1): 134–142
DOI: https://doi.org/10.5114/wiitm.2021.105725
Online publish date: 2021/04/30
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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:

postoperative pain, deep serratus plane block, superficial serratus anterior plane block, paravertebral nerve block, video-assisted thoracic surgery
  
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