Comparison of ultrasound-guided serratus plane block and thoracic paravertebral block for postoperative analgesia after thoracotomy: a randomized controlled trial

Abstract

Background Post-thoracotomy pain can be severe and difficult to control. Paravertebral block (PVB) has been proven to be effective in controlling post-thoracotomy pain; however, it has its own set of complications. Ultrasound-guided serratus plane block (SPB) is a newly described field block that may provide thoracic wall analgesia. Objective This prospective randomized controlled study was carried out to compare the analgesic effects of PVB and SPB on post-thoracotomy pain. Patients and methods The study was done on 60 adult patients aged 18–65 years undergoing thoracotomy for pulmonary resection. The patients were randomly allocated to receive either thoracic PVB or SPB guided by ultrasound before induction of general anesthesia. The primary outcome was the visual analogue scale, which was recorded on arrival to the ICU and then at 1, 2, 4, 8, 12, 18, and 24 h postoperatively both at rest and during coughing. The secondary outcomes were time to perform the block, onset of sensory block, number of blocked dermatomes, block success rate, total postoperative morphine consumption, and any complications related to the regional block. Results The time to perform the block was significantly shorter in SPB than in PVB (3.76±1.1 vs. 6.14±1.6 min, P Conclusion SPB had a shorter time to perform and a faster onset of action than thoracic PVB and provided adequate analgesia in the early postoperative period; however, postoperative morphine consumption was higher in patients who received SPB.