Video-assisted thoracic surgery (VATS) is emerging as the standard surgical procedure for both minor and major oncological lung surgery. Thoracic epidural analgesia (TEA) and paravertebral block (PVB) are established analgesic golden standards for open surgery such as thoracotomy. However, there is no gold standard for regional analgesia for VATS. Serratus anterior plane block (SAPB) is a novel ultrasound guided thoracic wall nerve block reported recently. We performed SAPB for perioperative analgesia together with general anaesthesia in patients undergoing VATS surgery and compared it with PVB. The aim of this study was to assess the efficacy and safety of ultrasound guided serratus anterior plane block (SAPB) compared with paravertebral block for controlling acute pain during and 24 hours after VATS.
Design: A prospective, randomized study.
Participants: All participants were cancer patients scheduled for VATS.
Twenty patients scheduled for VATS under general anaesthesia were allocated randomly into 1 of 2 groups with 10 patients each. SAPB was performed before surgery with a single injection of 30 mL of 0.25% levobupivacaine. In the PVB group, single injection of 20 ml of 0.25% levobupivacaine. Heart rate, mean arterial pressure, and the visual analog pain score (VAS) measurements were recorded for 24 hours. We also recorded consumption of Fentanyl during the surgery. Rescue analgesia using intravenous tramadol 50-100 mg, was administered if the VAS was >5.
Measurements and Main Results
Compared with preoperative values, the mean arterial pressure in the SAPB group did not change significantly in both groups (p = 0.181). VAS scores and the total dose of tramadol consumed were comparable in the both groups. We recorded statistically higher consumption of Fentanyl during the surgery in SAPB group (p< 0,05).
The ultrasound guided SAPB appeared to be a safe and effective alternative for postoperative analgesia especially after VATS surgery. Serratus block provides effective regional anaesthesia, suitable for VATS surgery with easier to preform and with less complications. However, the higher consumption of opioids during the surgery indicates that PVB is superior in intraoperative analgesia. This was a pilot study so; further data will need to be collected to support these findings.
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