Comparison of the intraoperative analgesic efficacy between ultrasound-guided deep and superficial serratus anterior plane block during video-assisted thoracoscopic lobectomy: A prospective randomized clinical trial

Abstract

Background: The serratus anterior plane block (SAPB) is a novel method that provides lateral chest wall analgesia. There are 2 methods of SAPB; deep and superficial SAPB. Each of these methods has been demonstrated to provide effective perioperative analgesia in thoracic surgery. The aim of this study was to compare the intraoperative hemodynamic and analgesic benefits of deep versus superficial SAPB during video-assisted thoracic surgery (VATS) lobectomy.

Methods: We performed a prospective, randomized, patient/assessor-blinded trial. We included patients who were 20 to 75 years of age and scheduled to undergo VATS lobectomy with American Society of Anesthesiologists physical status 1 or 2. Patients were randomly allocated to receive either ultrasound-guided deep SAPB (Group D) or superficial SAPB (Group S). The primary outcome was intraoperative remifentanil consumption. We also recorded intraoperative systolic blood pressure (SBP), heart rate (HR), emergence time, and doses of rescue drugs used to manage hemodynamic instability.

Results: Data for 50 patients undergoing 3-port VATS lobectomy were analyzed. Intraoperative remifentanil consumption did not differ significantly between Group D (n = 25, 715.62 ± 320.36 μg) and group S (n = 25, 721.08 ± 294.48 μg) (P = .97). Additionally, there were no significant differences between the 2 groups in SBP and HR at any time point, emergence time, or amount of rescue drugs used.

Conclusion: Our study suggests that the intraoperative analgesic efficacy is similar for deep and superficial SAPB during VATS lobectomy.

Figure 1

Ultrasound views for the deep and superficial serratus anterior plane blocks. The needle (arrows) tips were placed in the deep serratus plane (A) and superficial serratus plane (B). Dotted line shows the spread of local anesthetics. LA = local anesthetics, LD = latissimus dorsi muscle, SA = serratus anterior muscle.

Figure 2

Flow diagram of the study.

Figure 3

The box and whisker plot depicts systolic blood pressure during video-assisted thoracic surgery lobectomy. The middle line in the box represents the median; the upper and lower margins of the box represent the 75th and 25th percentiles, respectively, and the whiskers represent the maximum and minimum observations. There were no significant differences between Group D and Group S. Group D, patients who received deep serratus anterior plane block; Group S, patients who received superficial serratus plane block.

Figure 4

The box and whisker plot depicts the heart rate during video-assisted thoracic surgery lobectomy. The middle line in the box represents the median; the upper and lower margins of the box represent the 75th and 25th percentiles, respectively, and the whiskers represent the maximum and minimum observations. There were no significant differences between Group D and Group S. Group D, patients who received deep serratus anterior plane block; Group S, patients who received superficial serratus plane block.