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
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.