Ultrasound-Guided Serratus Anterior Plane Block Combined with Modified Parasternal Block in Pediatric Patients Undergoing Auricular Reconstruction Surgery Results in Superior Quality of Recovery Compared to a Standalone Serratus Anterior Plane Block.

Background: Serratus anterior plane block (SAPB) and parasternal block (PSB) are used in multimodal analgesia strategies to improve postoperative comfort and recovery. Their combined effectiveness for pediatric auricular reconstruction (AR) patients needs clarification.

Methods: A study was conducted on 100 children aged 8 to 12 undergoing autologous rib cartilage transplant in AR. Subjects were randomized into two groups: the ultrasound (US)-directed SAPB plus modified PSB group (SAPB+PSB group) and the US-guided SAPB alone group (SAPB group). The primary outcome was the 24 h postoperative Quality of Recovery-15 (QoR-15) score. The secondary endpoints were pain scores, surgical field bleeding scores, sufentanil consumption within 24 h post-surgery, the time to first ambulation, and incidence of complications.

Results: The SAPB+PSB group demonstrated significantly higher scores in physical comfort, emotional status, and pain aspects on the QoR-15 scale compared to the SAPB group, the difference was significant (P ≤ 0.001). No significant differences were observed between the groups in terms of psychological support and physical independence (P > 0.05). The total QoR-15 score was augmented among SAPB+PSB versus SAPB participants (P < 0.001). At 12 h, the SAPB+PSB group reported lower NRS scores than the SAPB group during rest (P < 0.001) and cough (P = 0.014). The sufentanil consumption at 24 h was substantially diminished among SAPB+PSB recipients (P < 0.001), and the time to first ambulation was shorter relative to the SAPB recipients, and the different was significant (P < 0.001).

Conclusion: US-guided SAPB combined with modified PSB significantly enhances postoperative recovery quality in pediatric patients undergoing AR, effectively improving postoperative comfort and facilitating recovery.

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