Comparison Among Ultrasound-Guided Thoracic Paravertebral Block, Erector Spinae Plane Block and Serratus Anterior Plane Block for Analgesia in Thoracotomy for Lung Surgery

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 in India. 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. 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.