Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial

Abstract

Background Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). This prospective randomized controlled trial was performed to analyze the postoperative analgesic effects of ultrasound-guided RIB block and RISS block after video-assisted thoracoscopic surgery. Methods Ninety patients aged between 18 and 80 years, with American Society of Anesthesiologists physical status Classes I–II and scheduled for elective unilateral VATS were randomly allocated into three groups. In group C, no block intervention was performed. Patients in group RIB received ultrasound-guided RIB with 20-mL 0.375% ropivacaine and those in group RISS received ultrasound-guided RIB and serratus plane block using a total of 40-mL 0.375% ropivacaine. All patients received intravenous sufentanil patient-controlled analgesia upon arrival in the recovery room. Postoperative sufentanil consumption and pain scores were compared among the groups. Results The dosages of sufentanil consumption at 24 h after the surgery in the RIB and RISS groups were significantly lower than that in group C (p < 0.001 and p < 0.001 for all comparisons, respectively), the postoperative Numerical Rating Scale (NRS) scores in the RIB and RISS groups at 0.5, 1, 3, 6, 12, 18, and 24 h after surgery when patients were at rest or active were significantly lower than that in group C (p < 0.05 for all comparisons). The required dosage of sufentanil and time to first postoperative analgesic request in groupRISS were less than those in the group RIB at 24 h after the surgery (p < 0.001 and p < 0.001 for all comparisons, respectively). Similarly, the Numerical Rating Scale scores for group RISS at 12, 18, and 24 h after the surgery when the patients were active were significantly lower than those for group RIB (p < 0.05 for all comparisons). Conclusion Both ultrasound-guided RIB block and RISS block can effectively reduce the demand for sufentanil within 24 h after VATS, and less sufentanil dosage is needed in patient with RISS block. Ultrasound-guided RIB block and RISS block can effectively relieve pain within 24 h after VATS, and RISS block is more effective.

Efficacy and Safety of Rhomboid Intercostal Block for Analgesia in Breast Surgery and Thoracoscopic Surgery: A Meta-Analysis

“…We used data from several secondary analyses of these studies in this meta-analysis. A total of 216 patients were enrolled in 4 included studies [15][16][17][18] , 108 in the RIB group, 108 in the control group with no blocks. The strategy of the research and the process of the selection were shown in the ow diagram of Fig.…”

“…1. All 4 [15][16][17][18] studies were randomised controlled trials published in peer reviewed journals. Two trials 17,18 compared RIB with no block.…”

“…Two trials 17,18 compared RIB with no block. One trials 15 compared RIB both to no block and to RIB combined with sub-serratus plane block, and one trials 16 compared RIB both to no block and to Type-II pectoral nerve block. Their results were analyzed separately.…”

“…For postoperative pain scores, three studies used NRS scores 15,17,18 and one used VAS scores 16 . Since the NRS score was consistent with the VAS score, the VAS score value was converted to the NRS score value for comparison 13,14 .…”

“…NRS at rest at the rst 0-1 h: Four trials [15][16][17][18] reported the NRS at rest at the rst 0-1 h and the random-effect model was used to analysis the outcome of them. The results showed that compared to no block group, RIB resulted in signi cantly lower NRS at rest at the rst 0-1 h (WMD= -1.55; 95% CI = -2.92 to -0.19; p < 0.05) with signi cant heterogeneity among the studies (I 2 = 99%, heterogeneity p < 0.0001).…”