Serratus anterior plane block alone, paravertebral block alone, and their combination in video-assisted thoracoscopic surgery: the THORACOSOPIC double-blind, randomized trial

Abstract OBJECTIVES Serratus anterior plane block (SAPB) and paravertebral block (PVB) are well known to reduce pain levels after video-assisted thoracic surgery (VATS). However, the relative efficacies of each block and a combination of the two have not been fully characterized. The objective of the present study was to assess the efficacy of PVB alone, SAPB alone, and the combination of PVB and SAPB with regard to the occurrence and intensity of pain after VATS. METHODS We conducted the THORACOSOPIC single-centre, double-blind, randomized trial in adult patients due to undergo elective VATS lung resection. The participants were randomized to PVB only, SAPB only and PVB+SAPB groups. The primary end-point was pain on coughing on admission to the postanaesthesia care unit (PACU). The secondary end-points were postoperative pain at rest and on coughing at other time points and the cumulative opioid consumption. Pain was scored on a visual analogue scale (VAS). RESULTS 156 patients (52 in each group) were included. On admission to the PACU, the three groups did not differ significantly with regard to the pain on coughing: the VAS score was 3 [0; 6], 4 [0; 8] and 2 [0; 6] in the PVB, SAPB and PVB+SAPB groups, respectively (P = 0.204). During postoperative care, the overall pain score was significantly lower in the SABP+PVP group at rest and on cough. CONCLUSIONS the combination of SABP+PVB could be beneficial for pain management in VATS in comparison to SABP or PVB alone.