A randomized clinical trial: optimal strategies of paravertebral nerve block combined with general anesthesia for postoperative analgesia in patients undergoing lobectomy: a comparison of the effects of different approaches for serratus anterior plane block.

Background: To observe the analgesic effect of different ultrasound-guided methods of serratus anterior plane block (SAPB) after surgery in patients who have undergone thoracoscopic lobectomy with general anesthesia combined with thoracic paravertebral nerve block.

Methods: A total of 120 patients aged 18-65 years old scheduled for video-assisted thoracoscopic surgery (VATS) were selected. Patients were randomly divided into 3 groups: patient-controlled intravenous analgesia (PCIA) group, serratus anterior plane block (SPB) group and continuous serratus anterior plane block (CSPB) group (n=40 each). All patients were treated with general anesthesia combined with double-point (T4, T7) thoracic paravertebral block. The SPB group received an ultrasound-guided single serratus plane block. The CSPB group underwent the same procedure as the SPB group, with an epidural catheter inserted. Both the PCIA and SPB groups received PCIA after surgery. Patients in the CSPB group were connected to a continuous serratus block automatic analgesia pump after surgery.

Results: There were no significant differences among the 3 groups in terms of the general condition. Compared with the PCIA group, the resting and exercise VAS pain scores at T2, T3, T4, and T5, cortisol level at T1, T4 and T5 in SPB group and CSPB group were lower (P<0.05), the times of the first analgesia were significantly prolonged, and the times of pressing the PCA pump and opioid use were significantly less in the SPB and CSPB groups, and the CSPB group used no opioids (P<0.05), the SPB group and CSPB group had shorter times of the first postoperative activity, longer mobilization distance and the total number of days in hospital was significantly lower (P<0.05). Postoperative complications in the SPB and CSPB groups were significantly less and the CSPB group had an even lower incidence of postoperative complications (P<0.05). Compared with the SPB group, active VAS pain scores at T4 and T5 were higher in the CSPB group (P<0.05). Compared with the PCIA group, the total QoR-40 score at T6 was significantly higher in the SPB and CSPB groups, and compared with the SPB group, this data was higher in the CSPB group (P<0.05).

Conclusions: Single ultrasound-guided SAPB combined with PCIA can provide a better analgesic effect, improve the quality of early postoperative recovery, and accelerate ERAS.

Trial Registration: Chinese Clinical Trial Registry ChiCTR2000041350.