Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial

Abstract

Background. Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). Methods. We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0–12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group P < 0.001 , and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups P = 0.813 . At 12–24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group P < 0.001 , and no great diversity in sufentanil consumption was found between the RIB and ESP groups P = 0.589 . No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24–48 hours P = 0.192 . At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group ( P < 0.05 for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients ( P < 0.05 for all contrasts). At 24 hours after surgery, a significant difference in IL-1β and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block ( P < 0.05 for all contrasts). However, no great diversities were observed in IL-1β, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively ( P < 0.05 for all comparisons). Conclusion. The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.

Comparing ultrasound-guided serratus anterior plane block with erector spinae plane block for postoperative analgesia in thoracic and breast surgery: A systematic review and meta-analysis

“…The literature search initially retrieved 1105 articles. Finally, after review and exclusion, 11 randomized controlled trials [23][24][25][26][27][28][29][30][31][32][33] met our inclusion criteria. The selected studies were published between 2019 and 2022 and were conducted in different countries, such as China, India, Turkey, Egypt and Ireland.…”

“…Eight studies involved patients undergoing breast surgery [23-26, 28, 29, 31, 33], and another three studies were performed on adult women undergoing breast surgery [27,30,32]. Of the included studies, eight studies used bupivacaine or levobupivacaine for nerve block [24-26, 28-31, 33], and the remaining three used ropivacaine [23,27,32]. Regarding the pain scale, most studies used the VAS, 4 studies used the NRS, and only one study used the VRS.…”

“…ESPB seems to have advantages in thoracic surgery. Zhang et al [23] and Elsabeeny et al [28] also found that the analgesic effect of ESPB was better than that of SAPB, and the consumption of opioids was lower. Mechanistically, it has been suggested that ESPB is considered to be similar to paravertebral block, a multidermatomal range of sensory block in the posterior, lateral and anterior walls of the chest, and ESPB blocks the thoracic spine dorsal and ventral branches of spinal nerves, causing some degree of sympathetic blockade.…”

“…Six studies reported intraoperative opioid consumption after the use of ESPB and SAPB in patients receiving thoracic or breast surgery [23,25,27,[30][31][32]. Meta-analysis revealed that compared with the SAPB group, patients in the ESPB group had signi cantly reduced intraoperative opioid consumption (SMD:…”

“…Five studies that included 261 patients [23,27,28,30,33] reported the time to rst analgesic use after use of the ESPB and SAPB in patients receiving thoracic or breast surgery. Meta-analysis revealed that ESPB signi cantly prolonged the time to rst analgesic use compared with SAPB (SMD: 3.53; 95% CI: 1.62 to 5.44; P < 0.001; I 2 = 97%) (Fig.…”