Effectiveness of Combining Thoracic Paravertebral Nerve Block and Serratus Anterior Plane Block in Non-Intubated Spontaneous-Ventilation Video-Assisted Thoracoscopic Surgery: A Retrospective Case-Control Study.

BACKGROUND

Thoracic paravertebral nerve block (TPNB) and serratus anterior plane block (SAPB) are commonly used regional anesthesia techniques for pain management after thoracic surgery. Non-intubated spontaneous-ventilation video-assisted thoracoscopic surgery (VATS) poses unique challenges in managing postoperative pain and ensuring rapid recovery. We hypothesize that in non-intubated spontaneous VATS, combining TPNB and SAPB may offer enhance pain relief and improve patient prognosis.

METHODS

This retrospective study analyzed 315 patients undergoing non-intubated VATS between March 2019 and December 2024, divided into three groups: 98 cases in the TPNB (T Group), 113 cases in the SAPB (S Group), and 104 cases in the combination of TPNB and SAPB (TS Group). The propensity score matching method was used to match the initial data in a 1:1:1 ratio, resulting in the T group (70 cases), S group (70 cases), and TS group (70 cases). Postoperative pain control, analgesic consumption and inflammatory markers were assessed in the matched three groups using standard statistical methods.

RESULTS

Compared with the T and S groups, the pain control of patients in the TS group was significantly better. At 12 hours, the visual analog scale (VAS) of the T group (5.27 ± 0.57) and the S group (5.09 ± 0.49) were significantly higher than those of the TS group (2.51 ± 0.36) (P<0.05); At 48 hours, both T group (2.87 ± 0.52) and S group (2.63 ± 0.49) were significantly higher than TS group (1.56 ± 0.24) (P<0.05). Compared with the T and S groups, patients in the TS group had a reduced consumption of analgesics. The average consumption of oxycodone in the T group was (49.65 ± 0.71) mg, slightly higher than that in the S group (45.42 ± 0.51) mg and the TS group (30.26 ± 0.53) mg (P<0.05). Compared with the T and S groups, the postoperative recovery quality of patients in the TS group was better. The total score of the QoR-15 scale in the TS group was (120.41 ± 7.75), which was significantly better than that in the T group (113.42 ± 7.65) and S group (112.95 ± 7.56) (P<0.05). Compared with the T and S groups, the inflammatory markers in the TS group were significantly reduced. For IL-1 β, the TS group showed a significant decrease at T1 [(15.33 ± 0.41) pg/mL] and T2 [(13.45 ± 0.71) pg/mL] (P<0.05); For TNF - α, the TS group also showed a significant decrease at T1 [(20.12 ± 1.66) pg/mL] and T2 [(18.42 ± 1.03) pg/mL] (P<0.05). In addition, the incidence of adverse reactions such as nausea, vomiting, and dizziness, as well as complications such as atelectasis, hypoxemia, and pulmonary infection, were lower in the TS group (P<0.05).

CONCLUSION

The combined use of TPNB and SAPB in non-intubated VATS substantially improves pain management, reduces opioid consumption and minimizes inflammation and postoperative complications compared to the use of individual blocks. These findings advocate for the broader adoption of combined nerve block techniques to enhance patient outcomes in VATS procedures.