Comparison of Paravertebral Block and Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia After Video-Assisted Thoracoscopic Surgery: A Prospective, Randomized Controlled Trial.

OBJECTIVES

To compare the analgesic efficacy of serratus posterior superior intercostal plane block (SPSIPB) versus thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracoscopic surgery (VATS), with a focus on postoperative opioid consumption and pain scores.

DESIGN

A prospective, randomized, controlled, single-center clinical trial.

SETTING

A tertiary university hospital.

PARTICIPANTS

Sixty adult patients aged 18 to 80 years scheduled for elective VATS. Participants were randomized in a 1:1 ratio to receive either SPSIPB (n = 30) or TPVB (n = 30). Baseline characteristics were comparable between groups.

INTERVENTIONS: Prior to induction of general anesthesia, patients received either ultrasound-guided SPSIPB or TPVB using 30 mL of 0.25% bupivacaine.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was cumulative 24-hour postoperative opioid consumption, expressed as oral morphine equivalents. Secondary outcomes included numeric rating scale (NRS, 0-10) for pain scores and the incidence of opioid-related adverse effects at 1, 3, 6, 12, and 24 hours after surgery. Twenty-four-hour opioid use was not significantly different between SPSIPB and TPVB (66.8 ± 29.4 mg v 77.2 ± 40.0 mg; mean difference -10.4 mg; 95% CI, -36.1 to 15.3; p = 0.439). No significant differences were seen in pain scores or opioid-related side effects at any assessed time point (p > 0.05).

CONCLUSIONS

SPSIPB and TPVB were associated with similar postoperative opioid consumption, pain scores, and the incidence of adverse effects following VATS. Given its potentially simpler application, SPSIPB may serve as an effective alternative regional analgesic technique in thoracic surgery.