Comparison of erector spinae plane block and serratus anterior plane block for pain management in thoracoscopic surgery

Abstract

Aims: This study was designed to compare the efficacy and safety of erector spinae plane block and serratus anterior plane block in VATS (video assisted thoracoscopic surgery) patients. Methods: This prospective, single-blinded, randomized controlled trial included fifty patients aged 18 to 70 years, classified as American Society of Anesthesiologists (ASA) physical status I-III, who were scheduled to undergo elective video-assisted thoracoscopic surgery (VATS) between February 2022 and February 2023. Patients were randomly assigned to receive either an erector spinae plane block (ESPB) or a serratus anterior plane block (SAPB). In the ESPB group, a catheter was inserted at the T5 vertebral level, and 30 ml of 0.25% bupivacaine was administered. In the SAPB group, the catheter was placed into the superficial fascia overlying the serratus anterior muscle at the level of the fifth rib, and the same volume and concentration of local anesthetic was used. Postoperatively, when the Numeric Rating Scale (NRS) pain score was ≥3, a patient-controlled analgesia (PCA) device delivering 0.125% bupivacaine was connected to the catheter, and continuous infusion was initiated. Intraoperative fentanyl consumption, time to PCA connection, NRS scores, and postoperative morphine use were recorded. Data were analyzed using R version 4.0.0. Appropriate parametric or non-parametric tests were used based on data distribution. Repeated measures were evaluated with the Friedman test, and a p-value <0.05 was considered statistically significant. Results: Intraoperative fentanyl consumption was significantly lower in the ESPB group (p<0.05). There was no significant difference between the groups in time to PCA connection, NRS scores, or postoperative morphine use (p>0.05). NRS scores decreased over time in both groups. No complications occurred. Conclusion: ESPB is superior for intraoperative analgesia, while both blocks are equally effective for postoperative pain management.

Keywords

• Video assisted thoracic surgery
• postoperative pain; regional anesthesia
• nerve block
• erector spinae plane block
• serratus anterior plane block

Torakoskopik cerrahide ağrı kontrolünde erector spinae ve serratus anterior plan bloklarının etkinliğinin karşılaştırılması

Abstract

Amaç: Bu çalışma, video yardımlı torakoskopik cerrahi (VATS) geçiren hastalarda erector spinae plan bloğu (ESPB) ile serratus anterior plan bloğunun (SAPB) etkinliğini ve güvenliğini karşılaştırmak amacıyla tasarlanmıştır. Yöntemler: Bu prospektif, tek kör, randomize kontrollü çalışmaya Şubat 2022 ile Şubat 2023 tarihleri arasında elektif video yardımlı torakoskopik cerrahi (VATS) planlanan, Amerikan Anesteziyoloji Derneği (ASA) fiziksel durum sınıflaması I–III olan, 18–70 yaş aralığındaki elli hasta dahil edildi. Hastalar rastgele olarak ESPB veya SAPB gruplarına atandı. ESPB grubuna, T5 seviyesinden bir kateter yerleştirilerek 30 ml %0,25 bupivakain uygulandı. SAPB grubuna ise serratus kasının yüzeyel fasyasına, beşinci kosta seviyesinde bir kateter yerleştirilerek aynı doz uygulandı. Postoperatif dönemde, Sayısal Ağrı Skalası (NRS) skoru ≥3 olduğunda, %0.125 bupivakain içeren hasta kontrollü analjezi (PCA) cihazı katetere bağlandı ve sürekli infüzyona başlandı. İntraoperatif fentanil tüketimi, PCA bağlantı süresi, NRS skorları ve postoperatif morfin kullanımı kaydedildi. Veriler R versiyon 4.0.0 ile analiz edildi. Veri dağılımına göre uygun parametrik veya non-parametrik testler kullanıldı. Tekrarlayan ölçümler Friedman testi ile değerlendirildi ve p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: İntraoperatif fentanil tüketimi ESPB grubunda anlamlı derecede daha düşüktü (p<0.05). PCA bağlantı süresi, NRS skorları ve postoperatif morfin kullanımı açısından gruplar arasında anlamlı fark bulunmadı (p>0.05). Her iki grupta da NRS skorları zamanla azaldı. Herhangi bir komplikasyon görülmedi. Sonuç: ESPB, intraoperatif analjezi açısından daha üstündür; ancak her iki blok da postoperatif ağrı yönetiminde eşit derecede etkilidir.

Keywords

• video yardımlı torasik cerrahi
• postoperatif ağrı
• rejyonel anestezi
• sinir bloğu

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