Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial

Abstract

Introduction Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video or robot-assisted thoracic surgery (VATS or RATS). Methods The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24-hr between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6-hr and 24-hr and morphine-related complications were also assessed. Results 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24-hr between the 2 groups (p = 0.1640). At 6-hr, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0;4] vs. 2 [0;3], p = 0.0231). There were no differences between the 2 groups for pain at 24-hr and morphine related-complications. Conclusion We did not find any difference in morphine consumption between the two groups. Our results suggest that the combination of PVB and SAPB for VATS or RATS is safe effective and reliable and could be an alternative to PVB alone in certain indications.

Serratus anterior plane block alone, paravertebral block alone and their combination in video-assisted thoracoscopic surgery: the THORACOSOPIC double-blind, randomized trial

“…Another key finding was that the PVB + SAPB combination was not associated with lower postoperative pain level at PACU admission when compared with the single blocks alone. To date, only 1 randomized trial has measured the efficacy of the PVB + SAPB combination [ 21 ]. In contrast to our study, Dusseaux et al found that the PVB + SAPB combination was superior to PVB alone, with a significantly lower postoperative pain score 6 h after surgery.…”

Loco-Regional Anesthesia for Pain Management in Robotic Thoracic Surgery

“…These advantages seem comparable to the ones reported with the use of INB [ 71 ]. However, the combination of SAPB and PVB does not seem to provide better analgesia as compared to PVB alone [ 72 ]. Another advantage provided by SAPB is that it can be performed with the patient in a supine position, which aligns with the positioning required for robotic thoracic procedures, thereby streamlining the workflow [ 73 ].…”