Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study
Bloqueio do plano intercostal do serrátil posterior superior versus bloqueio paravertebral torácico para controle da dor após cirurgia toracoscópica assistida por vídeo: um estudo prospectivo randomizado
Güvenç Doğan, Onur Küçük, Selçuk Kayır, Gökçe Çiçek Dal, Bahadır Çiftçi, Musa Zengin, Ali Alagöz
Abstract
Background
Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.
Methods
In this randomized, prospective, double-blind study, 70 patients aged 18−65 years (ASA I−III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.
Results
The mean age of the patients was 52 § 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p > 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8−28] vs. 26 [18.5−33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135−260) in the TPVB group versus 150 mg (110−230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7−10] vs. 9 [7−10], p = 0.789).
Conclusions
SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.
Keywords
Resumo
Introdução
A Cirurgia Toracoscópica Assistida por Vídeo (VATS) é um procedimento minimamente invasivo associado a recuperação mais rápida e menos complicações em comparação à toracotomia aberta. O manejo eficaz da dor pós-operatória é importante para otimizar a recuperação. Este estudo compara a eficácia analgésica do Bloqueio do Plano Intercostal do Serrátil Posterior Superior (SPSIPB) e do Bloqueio Paravertebral Torácico (TPVB) para dor pós-operatória após VATS.
Métodos
Neste estudo prospectivo, randomizado e duplo-cego, 70 pacientes com idades entre 18 e 65 anos (ASA I–III) submetidos a VATS foram aleatoriamente designados para o Grupo TPVB (n = 35) ou Grupo SPSIPB (n = 35). O desfecho primário foi o escore de dor em repouso pela Escala Visual Analógica (VAS) nas 24 horas pós-operatórias. Desfechos secundários incluíram escores de dor pela VAS durante tosse, tempo até o primeiro pedido de opioide, consumo total de opioides em 24 horas, satisfação do paciente e escores do Quality of Recovery-15 (QoR-15). O consumo de opioides foi avaliado por tramadol intravenoso via Analgesia Controlada pelo Paciente (PCA), com morfina adicional se necessário.
Resultados
A idade média dos pacientes foi 52 ± 11 anos, sendo 64,2% do sexo masculino. Os escores de dor pela VAS foram avaliados em 24 horas e em sete outros pontos temporais. Não houve diferença significativa entre os grupos (p > 0,05), exceto 1 hora após a cirurgia, quando o grupo TPVB apresentou escore VAS em repouso significativamente menor (19 [8–28] vs. 26 [18,5–33], p = 0,031). O consumo total de tramadol em 24 horas foi 220 mg (135–260) no grupo TPVB versus 150 mg (110–230) no grupo SPSIPB (p = 0,129). A proporção de pacientes que necessitaram analgesia adicional foi 25,7% no grupo TPVB versus 28,5% no grupo SPSIPB (p = 0,788). Os escores pré e pós-operatórios do QoR-15 foram semelhantes entre os grupos (pré-operatório: 137 vs. 136, p = 0,878; pós-operatório: 133 vs. 132, p = 0,814). A satisfação dos pacientes também foi comparável (8 [7–10] vs. 9 [7–10], p = 0,789).
Conclusão
O SPSIPB oferece eficácia analgésica semelhante ao TPVB para VATS, com escores de dor, consumo de opioides e resultados de recuperação comparáveis. Dada a facilidade de uso e perfil de segurança, o SPSIPB representa uma alternativa promissora ao TPVB na analgesia multimodal para cirurgia torácica minimamente invasiva.
Palavras-chave
References
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Submitted date:
02/04/2025
Accepted date:
05/28/2025
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