A randomized clinical trial: optimal strategies of paravertebral nerve block combined with general anesthesia for postoperative analgesia in patients undergoing lobectomy: a comparison of the effects of different approaches for serratus anterior plane block

Abstract

Background: To observe the analgesic effect of different ultrasound-guided methods of serratus anterior plane block (SAPB) after surgery in patients who have undergone thoracoscopic lobectomy with general anesthesia combined with thoracic paravertebral nerve block.Methods: A total of 120 patients aged 18-65 years old scheduled for video-assisted thoracoscopic surgery (VATS) were selected. Patients were randomly divided into 3 groups: patient-controlled intravenous analgesia (PCIA) group, serratus anterior plane block (SPB) group and continuous serratus anterior plane block (CSPB) group (n=40 each). All patients were treated with general anesthesia combined with doublepoint (T4, T7) thoracic paravertebral block. The SPB group received an ultrasound-guided single serratus plane block. The CSPB group underwent the same procedure as the SPB group, with an epidural catheter inserted. Both the PCIA and SPB groups received PCIA after surgery. Patients in the CSPB group were connected to a continuous serratus block automatic analgesia pump after surgery.Results: There were no significant differences among the 3 groups in terms of the general condition.Compared with the PCIA group, the resting and exercise VAS pain scores at T2, T3, T4, and T5 , cortisol level at T1, T4 and T5 in SPB group and CSPB group were lower (P<0.05), the times of the first analgesia were significantly prolonged, and the times of pressing the PCA pump and opioid use were significantly less in the SPB and CSPB groups, and the CSPB group used no opioids (P<0.05), the SPB group and CSPB group had shorter times of the first postoperative activity, longer mobilization distance and the total number of days in hospital was significantly lower (P<0.05). Postoperative complications in the SPB and CSPB groups were significantly less and the CSPB group had an even lower incidence of postoperative complications (P<0.05).Compared with the SPB group, active VAS pain scores at T4 and T5 were higher in the CSPB group (P<0.05).Compared with the PCIA group, the total QoR-40 score at T6 was significantly higher in the SPB and CSPB groups, and compared with the SPB group, this data was higher in the CSPB group (P<0.05).Conclusions: Single ultrasound-guided SAPB combined with PCIA can provide a better analgesic effect, improve the quality of early postoperative recovery, and accelerate ERAS.

The Association of Regional Block with Intraoperative Opioid Consumption in Patients Undergoing Video-Assisted Thoracoscopic Surgery: a single-center, retrospective study

“…Er, et al reported that compared with GA, SAPB was associated with shorter hospital stay, as it was associated with improved quality of recovery scores by reducing early postoperative pain scores. [33] Nevertheless, the reduction in length of PACU or hospital stay observed in our study did not seem to be encouraging enough for clinical practice. As to the postoperative complications, we could not draw any conclusion due to small sample size.…”

“…[12,13] Regional blocks were believed to be potential to promote early mobilization in patients after VATs since it could reduce the incidence of moderate to severe pain in the early postoperative period. [10,11,28,33] It was reported that the use of regional block reduced postoperative opioid consumption and prolonged the time-to-rst rescue analgesic in patients after VATs compared with those who did not receive regional blocks. [14,24,33,34] Recent studies compared the analgesic effects of TEA, TPVB, and SAPB in patients after VATs and found that they were comparable in terms of opioid-sparing effects and postoperative pain scores.…”

“…[10,11,28,33] It was reported that the use of regional block reduced postoperative opioid consumption and prolonged the time-to-rst rescue analgesic in patients after VATs compared with those who did not receive regional blocks. [14,24,33,34] Recent studies compared the analgesic effects of TEA, TPVB, and SAPB in patients after VATs and found that they were comparable in terms of opioid-sparing effects and postoperative pain scores. [17,24,25,28,30,32] Our study did not show that the choice of regional block was associated with prolonged time-to-rst rescue analgesic.…”

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis.

“…Table I illustrates the included studies, the number of participants and the data nodes involved for seven different outcome events. Of the included studies, 28 RCTs [ 10 – 37 ] reported opioid consumption; from 49 RCTs [ 10 , 12 , 14 – 17 , 19 , 21 – 26 , 28 – 30 , 32 , 34 – 65 ], 41 RCTs [ 10 , 12 , 15 – 17 , 19 , 21 – 26 , 28 , 29 , 31 , 32 , 34 – 37 , 39 – 43 , 45 – 49 , 51 , 54 , 56 , 57 , 59 – 65 ], and 49 RCTs [ 10 , 12 , 14 – 17 , 19 – 26 , 28 – 32 , 34 – 46 , 48 – 53 , 55 – 63 , 65 , 66 ], we obtained pain scores for three postoperative time periods (early, midterm, and late); and 10 RCTs [ 10 , 16 , 20 , 21 , 25 , 28 , 32 , 35 , ...…”

Acute pain management after thoracoscopic lung resection: a systematic review and explorative meta-analysis

“…Most studies applying single-shot techniques included only ASA I and II patients [ 38 , 54 , 55 , 65 ] and uniportal VATS techniques [ 48 , 71 ] possibly creating a selection bias of patients with an advantage in rapid recovery and early discharge. Moreover, single-shot unilateral techniques were also accompanied by adjuvants such as dexmedetomidine, nalbuphine and dexamethasone [ 55 , 65 , 78 ] as well as experimental studies using liposomal bupivacaine [ 67 , 68 ], thereby extending the efficacy of single-shot blocks promoting ERATS. All factors taken into consideration, not only the applied analgesic technique has an impact on LOS, but the tendency to follow ERATS protocols and studies focusing on pain control, create a clear advantage resulting in early hospital discharge.…”