Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery

Abstract

BACKGROUND Serratus anterior plane blocks (SAPBs) and thoracic paravertebral blocks (TPVBs) can both be used for video-assisted thoracic surgery. However, it remains unknown whether the analgesic efficacy of a SAPB is comparable to that of a TPVB. OBJECTIVE We tested the primary hypothesis that SAPBs provide noninferior analgesia compared with TPVBs for video-assisted thoracic surgery. DESIGN A noninferiority randomised trial. SETTING Shanghai Chest Hospital, between August 2018 and November 2018. PATIENTS Ninety patients scheduled for video-assisted thoracic lobectomy or segmentectomy were randomised. Patients were excluded if they were unable to perform the visual analogue pain scale, or surgery was converted to thoracotomy. INTERVENTIONS Blocks were performed after induction of general anaesthesia. The three groups were paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29); and general anaesthesia alone (n = 30). PRIMARY OUTCOME MEASURES Visual analogue pain scores (0 to 10 cm) at rest and while coughing, and Prince-Henry pain scores (0 to 4 points) were used to assess postoperative analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1 cm or one point as appropriate. RESULTS The mean difference (95% confidence intervals) in visual analogue scores between the SAPBs and TPVBs was −0.04 (−0.10 to 0.03) cm at rest, −0.22 (−0.43 to −0.01) cm during coughing and −0.10 (−0.25 to 0.05) for Prince-Henry pain scores. As the upper limit of the confidence intervals were less than 1 (all P < 0.001), noninferiority was claimed for all three primary outcomes. Compared with general anaesthesia alone, the VAS scores at rest and while coughing, and the Prince-Henry pain scores for the two blocks were significantly lower during the initial 2 h after surgery. CONCLUSIONS Serratus anterior plane blocks are quicker and easier to perform than paravertebral blocks and provide comparable analgesia in patients having video-assisted thoracic surgery. Both blocks provided analgesia that was superior to general anaesthesia alone during the initial 2 h after surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier: ChiCTR1800017671.

Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study

“… 36–38 It has been reported that regional techniques combined with general anaesthesia provide better perioperative analgesia by completing the somatosensorial and sympathetic block and have an opioid analgesic sparing effect. 39 The results of our study suggest that the average NRS score within 48 h postoperatively in group TG was significantly lower than that in group GA ( P <0.05), which is consistent with the results of Qiu et al 40 who found that TPVB provided analgesia that was superior to general anaesthesia alone during the initial 2 h after VATS in a noninferiority randomized trial. Our results are also similar to those from a study by Chu et al 6 who demonstrated that TPVB could provide statistically better pain relief in VATS lobectomy in a randomized clinical trial.…”

“…The dosage of intraoperative and postoperative sufentanil in group TG was significantly lower than in group GA ( P <0.01). This indicated that TPVB could significantly reduce perioperative pain, which was consistent with the results of Qiu et al 40 who found that PTVB reduced the use of sufentanil during surgery by about 30%, and that patients required smaller amounts of rescue drugs within 24 h after operation. Zhang et al 43 demonstrated that the reduced consumption of remifentanil occurred in response to TPVB in patients undergoing pulmonary surgery in a randomized trial.…”

“…The results showed that the incidence of adverse reactions (PONV) after surgery in group TG was significantly lower than those in group GA ( P <0.05), which was consistent with previous studies. 40 , 44 , 45 All these results implied that the TPVB and the opioid were secure.…”

Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

“…However, a small randomized trial failed to find any difference in pain scores or opioid consumption in patients who receive either SAPB or ICNB for VATS (124). Interestingly, a recent randomized non-inferiority trial of SAPB and PVB for VATS showed no significant difference in post-operative pain scores at two hour between the two approaches, but also no difference in pain scores for either compared to no block at 24 or 48 hours, and no difference in 24 hours post-operative opioid consumption (125).…”

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

“…TPVB is a unilateral block technique; therefore, contralateral respiratory and sympathetic functions can be preserved. This function may be associated with reduced PPCs, postoperative bleeding, and urinary retention [51]. The complications of TPVB are similar to those of TEA; however, spinal cordrelated complications are more likely to occur after TEA, whereas pulmonary complications are more common after TPVB [52].…”