Thoracic paravertebral versus serratus anterior plane block in thoracic surgery—a randomized trial

Background: Pain after thoracotomy is often severe and may lead to postoperative complications. Although various regional anesthesia techniques are used to manage thoracotomy pain, further evidence is needed regarding the efficacy of the serratus anterior plane block (SAPB). This randomized controlled study aimed to compare the postoperative analgesic efficacy of ultrasound-guided single-injection thoracic paravertebral block (TPVB) with deep SAPB in patients undergoing lung resection via thoracotomy. Methods: Sixty American Society of Anesthesiologists (ASA) physical status I–III patients aged 18–75 years scheduled for elective thoracotomy were randomized to receive either TPVB or SAPB using 20 mL of 0.5% bupivacaine. All patients received postoperative patient-controlled intravenous morphine. Morphine consumption, visual analogue score (VAS), postoperative nausea and vomiting (PONV), and analgesia requirements were recorded at predetermined intervals. The primary outcome was 24-hour postoperative opioid consumption. Secondary outcomes included static and dynamic VAS pain scores, rescue analgesia requirements, and complications. Results: Data from 58 patients were analyzed. TPVB significantly reduced morphine consumption at all measured time points (3, 6, 9, 12, and 24 hours). Total 24-hour opioid consumption was lower in the TPVB group than in the SAPB group (8 mg vs. 14 mg; p < 0.001). Rescue analgesia needs were higher in the SAPB group at 9th and 12th postoperative hours. TPVB also resulted in lower VAS scores at multiple time points and lower (PONV). Conclusions: Compared to SAPB, TPVB provided superior analgesia following thoracotomy, resulting in lower opioid requirements, improved pain scores, and fewer opioid-related side effects. Clinical Trial Registration: The study was retrospectively registered with ClinicalTrials.gov (Registration No: NCT06177652).

Thoracotomy; Thoracic paravertebral block; Serratus anterior plane block; Postoperative pain; Regional anesthesia

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