Korean J Pain.  2021 Apr;34(2):234-240. 10.3344/kjp.2021.34.2.234.

Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study

• Baytar MS
• Yılmaz C
• Karasu D
• Baytar

• KMID: 2514423
• DOI: http://doi.org/10.3344/kjp.2021.34.2.234

Abstract

Background
Various truncal block techniques with ultrasonography (USG) are becoming widespread to reduce postoperative pain and opioid requirements in video-assisted thoracoscopic surgery (VATS). The primary aim of our study was to determine whether the USG-guided serratus anterior plane block (SAPB) is as effective as the thoracic paravertebral block (TPVB) in VATS. Our secondary aim was to evaluate patient and surgeon satisfaction, block application time, first analgesic time, and length of hospital stay.
Methods
Patients in Group SAPB received 0.4 mL/kg bupivacaine with a USG-guided SAPB, and patients in Group TPVB received 0.4 mL/kg bupivacaine with a USGguided TPVB. We recorded the pain scores, the timing of the first analgesic requirement, the amount of tramadol consumption, and postoperative complications for 24 hours. We also recorded the block application time and length of hospital stay.
Results
A total of 62 patients, with 31 in each group (Group SAPB and Group TPVB) completed the study. Between the two groups, there were no significant differences in rest and dynamic pain visual analog scale scores at 0, 1, 6, 12, and 24 hours after surgery. The total consumption of tramadol was significantly lower in the TPVB group (P = 0.026). The block application time was significantly shorter in Group SAPB (P < 0.001).
Conclusions
An SAPB that is applied safely and rapidly as a part of multimodal analgesia in patients who undergo VATS is not inferior to the TPVB and can be an alternative to it.

Keyword

Analgesia; Patient-Controlled; Analgesics; Opioid; Bupivacaine; Intermediate Back Muscles; Nerve Block; Pain; Postoperative; Paraspinal Muscles; Thoracic Surgery; Video-Assisted; Tramadol; Ultrasonography

Figure

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  Fig. 1 Serratus anterior plane block application. LDM: latissimus dorsi muscle, SAM: serratus anterior muscle, LA: local anesthetic.

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  Fig. 2 Thoracic paravertebral block application. TM: trapezius muscle, ESM: erector spinae muscle, TP: transverse process, PVS: paravertebral space.

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  Fig. 3 Trial flow diagram. TPVB: thoracic paravertebral block, SAPB: serratus anterior plane block, USG: ultrasonography, PCA: patient-controlled analgesia.

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