Comparison Among Ultrasound-Guided Thoracic Paravertebral Block, Erector Spinae Plane Block and Serratus Anterior Plane Block for Analgesia in Thoracotomy for Lung Surgery

Published:August 31, 2022DOI:


      To compare the analgesic efficacy and safety of preoperative, single-shot ultrasound-guided thoracic paravertebral block (TPVB), erector spinae plane block (ESB), and serratus anterior plane block (SAPB) in thoracotomy pain.


      A prospective, randomized study.


      The cardiothoracic operating room and intensive care unit of a tertiary-care hospital in India.


      Ninety adult patients scheduled to undergo posterolateral thoracotomy for lung surgery under general anesthesia were recruited and randomized into 3 equal groups.


      Preoperatively, the patients received ultrasound-guided, single-shot nerve blocks within their respective groups, as follows: Erector spinae plane block in the ESB group, Thoracic paravertebral block in the TPVB group, and Serratus anterior plane block in the SAPB group.

      Measurements and Results

      The primary outcome measure, the visual analog scale (VAS) score, was recorded postoperatively in the intensive care unit at 0, 3, 6, 12, and 24 hours. The secondary outcome measures were the time to first rescue analgesic, total rescue opioid dose used, patient satisfaction at 24 hours, success of one-time attempt, and occurrence of adverse events.
      Data were statistically analyzed and a significant difference was found in the VAS score at all time points, the time to rescue analgesic and total opioid dosage, and patient satisfaction level (p < 0.05) among the groups with only 1 incidence of hypotension in the TPVB group. From post hoc analysis, ESB was found to have better analgesic efficacy compared with TPVB and SAPB. Serratus anterior plane block was found to be least efficacious and shortest acting among the three.


      The nerve blocks in decreasing order of analgesic efficacy in relieving post-thoracotomy pain would be ESB, TPVB, and SAPB.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fang B
        • Wang Z
        • Huang X.
        Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: A single center randomized controlled double-blind study.
        Ann Transl Med. 2019; 7: 174
        • Saad FS
        • Baradie SYE
        • Aliem MAWA
        • et al.
        Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for perioperative analgesia in thoracotomy.
        Saudi J Anaesth. 2018; 12: 565-570
        • Mijatovic D
        • Bhalla T
        • Farid J.
        Post-thoracotomy analgesia.
        Saudi J Anaesth. 2021; 15: 341-347
        • Yeung JH
        • Gates S
        • Naidu BV
        • et al.
        Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.
        Cochrane Database Syst Rev. 2016; 2CD009121
        • Davies RG
        • Myles PS
        • Graham JM.
        A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy - a systematic review and meta-analysis of randomized trials.
        Br J Anaesth. 2006; 96: 418-426
        • Foreo M
        • Adhikary SD
        • Lopez H
        • et al.
        The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain.
        Reg Anesth Pain Med. 2016; 41: 621-627
        • Khalil AE
        • Abdallah NM
        • Bashandy GM
        • et al.
        Ultrasound guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain.
        J Cardiothorac Vasc Anesth. 2017; 31: 152-158
        • Farzanegan B
        • Zangi M
        • Saeedi K
        • et al.
        Effect of adding magnesium sulfate to epidural bupivacaine and morphine on post-thoracotomy pain management: A randomized, double-blind, clinical trial.
        Basic Clin Pharmacol Toxicol. 2018; 123: 602-606
        • Todd KH
        • Funk KG
        • Funk JP
        • et al.
        Clinical significance of changes in pain severity.
        Ann Emerg Med. 1996; 27: 485-489