Doğan Güvenç, Küçük Onur, Kayır Selçuk, Dal Gökçe Çiçek, Çiftçi Bahadır, Zengin Musa, Alagöz Ali
Hitit University Faculty of Medicine, Department of Anesthesiology and Reanimation, Çorum, Turkey.
University of Health Sciences, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey.
Braz J Anesthesiol. 2025 Jun 3;75(5):844647. doi: 10.1016/j.bjane.2025.844647.
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.
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 Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.
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).
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.
与开胸手术相比，电视辅助胸腔镜手术（VATS）是一种微创手术，恢复更快，并发症更少。有效的术后疼痛管理对于优化恢复很重要。本研究比较了后上锯肌肋间平面阻滞（SPSIPB）和胸椎旁神经阻滞（TPVB）对VATS术后疼痛的镇痛效果。
在这项随机、前瞻性、双盲研究中，70例年龄在18 - 65岁（ASA I - III级）接受VATS的患者被随机分为TPVB组（n = 35）或SPSIPB组（n = 35）。主要结局是术后24小时静息状态下的视觉模拟量表（VAS）疼痛评分。次要结局包括咳嗽时的VAS疼痛评分、首次要求使用阿片类药物的时间、24小时内阿片类药物的总消耗量、患者满意度以及恢复质量-15（QoR-15）评分。通过患者自控镇痛（PCA）使用静脉注射曲马多评估阿片类药物的消耗量，必要时追加吗啡。
患者的平均年龄为52±11岁，64.2%为男性。在24小时及七个时间点评估VAS疼痛评分。除术后1小时外，两组之间无显著差异（p>0.05），术后1小时TPVB组的静息VAS评分显著更低（19[8 - 28] vs. 26[18.5 - 33]，p = 0.031）。TPVB组24小时曲马多总消耗量为220 mg（135 - 260），SPSIPB组为150 mg（110 - 230）（p = 0.129）。TPVB组需要追加镇痛的患者比例为25.7%，SPSIPB组为28.5%（p = 0.788）。两组术前和术后的QoR-15评分相似（术前：137 vs. 136，p = 0.878；术后：133 vs. 132，p = 0.814）。患者满意度评分也相当（8[7 - 10] vs. 9[7 - 10]，p = 0.789）。
SPSIPB对VATS的镇痛效果与TPVB相似，疼痛评分、阿片类药物消耗量和恢复结局相当。鉴于其易用性和安全性，SPSIPB在微创胸外科多模式镇痛中是TPVB的一个有前景的替代方法。
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