Ultrasound-guided serratus anterior plane block combined with erector spinae plane block for intra- and post-operative analgesia after video-assisted thoracoscopic lobectomy

Abstract

Objective To investigate the effect of ultrasound-guided serratus anterior plane block (SAPB) combined with erector spinae plane block (ESPB) on intraoperative opioid consumption and postoperative analgesia in patients undergoing video-assisted thoracoscopic (VAST) lobectomy. Methods A total of 120 patients undergoing elective VAST lobectomy were randomized into 4 groups before the operation. After general anesthesia, the patients were given ESPB (E group), SAPB (S group), SAPB+ESPB (SE group) and general anesthesia only (G group). All the patients received patient-controlled intravenous analgesia (PCIA) after the operation. The amount of intraoperative opioid consumption, postoperative Visual Analogue Scale (VAS) scores at rest and when coughing, and adverse events and complications associated with analgesia were recorded in all the cases. Results Compared with those in G group, the postoperative VAS scores were significantly lower in the other 3 groups (P 0.05). The intraoperative consumption of opioids, duration of PACU stay and sedation irritability score were all significantly lower or shorter in E, S and SE groups than in G group (P 0.05). The mean length of hospital stay was significantly shorter in E, S and SE groups than in G group, and was significantly shorter in SE group than in E group (P 0.05), although SE group had a shorter hospital stay than S group by 0.76 d. Conclusion Ultrasound-guided SAPB, ESPB, and particularly their combination can reduce the intraoperative dose of opioids during VAST lobectomy, lower the incidence of delirium in PACU and shorten the duration of PACU stay without increasing adverse reactions to promote the patients' early recovery and discharge.

Keywords

• serratus anterior plane block
• erector spinae plane block
• lobectomy
• thoracoscopic surgery
• postoperative analgesia