A Randomized Trial to Compare Serratus Anterior Plane Block and Erector Spinae Plane Block for Pain Management Following Thoracoscopic Surgery

Abstract

Objective Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. Methods A total of 60 patients were randomized into two groups (N = 30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Results Intraoperative and postoperative opioid consumption at 0–8, 8–16, and 16–24 hours and rescue analgesic use were significantly lower in the ESPB group (P < 0.05). Static/dynamic VAS scores were significantly lower in the ESPB group (P < 0.05). There was no significant difference between static VAS scores at the fourth hour. There were no differences between adverse effects. Block procedure time and one-time puncture success were similar between groups (P > 0.05 each). Conclusion US-guided ESPB may provide better pain control than SAPB after VATS. Question Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. Findings This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Meaning Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB.

Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study

“…[ 6 ] Also, other researchers have demonstrated that ESPB had superior analgesia to SAPB after thoracotomy and video-assisted thoracoscopy. [ 7 8 ]…”

Opioid‐sparing effects of ultrasound‐guided erector spinae plane block for adult patients undergoing surgery: A systematic review and meta‐analysis

“…The blockade of the erector spinae plane may have similar analgesic effects to epidural or paravertebral nerve block; however, the potential risk of spinal cord injury is negligible 67–69 . ESPB also has better postoperative analgesic effects compared to other nerve blocks, such as serratus anterior plane block and transversus abdominis plane block 70,71 …”

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

“…73 Randomized studies [74][75][76] and a meta-analysis 77 have demonstrated SAPB improves pain scores, respiratory mechanics, and opioid consumption after VATS but may not be superior to ESPB. [78][79][80] Therefore, SAPB is seen as an alternative to ESPB and PVB until more data are available. 19 In minimally invasive cardiac surgery, SAPB appears to be safe and effective even in the setting of anticoagulation.…”