Paravertebral block combined with serratus anterior plane block after video-assisted thoracic surgery: a prospective randomized controlled trial

• Published in: European journal of cardio-thoracic surgery 2023-07, Vol.64 (1)
• Main Authors: Dusseaux, Marie-Mélody, Grego, Victor, Baste, Jean-Marc, Besnier, Emmanuel, Boujibar, Fairuz, Koscianski, Godefroy, Ben Yahia, Mohamed Mehdi, Compere, Vincent, Clavier, Thomas, Vannier, Margot, Selim, Jean
• Format: Article
• Language: English
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezad170

Abstract OBJECTIVES Adequate pain management after thoracoscopic surgery is a major issue in the prevention of respiratory complications. The combination of the paravertebral block (PVB) with the serratus anterior plane block (SAPB) may decrease postoperative pain. The objective of this study was to evaluate the impact of the combination of PVB and SAPB on the consumption of morphine and pain after video- or robot-assisted thoracic surgery. METHODS The main objective of this randomized controlled trial was to compare the cumulative postoperative morphine consumption at 24 h between a group having PVB (PVB group) and a group having PVB and SAPB (PV-SAPB group). Postoperative pain at 6 and 24 h and morphine-related complications were also assessed. RESULTS A total of 112 patients were included with 56 in each group. There was no difference in median cumulative morphine consumption at 24 h between the 2 groups (P = 0.1640). At 6 h, the median postoperative pain was higher in the PVB group compared to the PV-SAPB group (3 [0; 4] vs 2 [0; 3], P = 0.0231). There were no differences between the 2 groups for pain at 24 h and morphine-related complications. CONCLUSIONS We did not find any difference in morphine consumption between the 2 groups. Our results suggest that the combination of PVB and SAPB for video-assisted thoracic surgery or robot-assisted thoracic surgery is safe effective and reliable and could be an alternative to PVB alone in certain indications. The management of acute postoperative pain is a major issue in thoracic surgery.