Comparison of ultrasonography-guided erector spinae and superficial serratus anterior plane blocks in thoracoscopic surgery with patient-controlled analgesia method

Erector Spinae Plane Block (ESPB) and Serratus Anterior Plane Block (SAPB), which are used in analgesic management of Video Assisted Thoracoscopic Surgery (VATS), are the interfascial plan blocks done with the assistance of ultrsonography and have lesser complication rates and more simple applicability relative to Paravertebrale Block (PVB) and Thoracic Epidural Analgesia (TEA). ESPB was first defined and described by Forero et al. in 2016. It should be administered at the T5 vertebrae level to provide analgesia in the thoracic region. SAPB was first defined and described by Blanco et al. in 2013. This block, applied at the level of the fifth rib, mainly blocks the upper and middle thoracic dermatomes of the lateral chest wall. The aim of this study is to compare the analgesic efficacy of ESPB and SAPB in analgesia management after VATS. After obtaining the approval of Pamukkale University Faculty of Medicine ethics committee (decision no:3 dated 08.02.2022) and patient consent, 50 patients (18-70 years old) who were planned for elective VATS surgery under general anaesthesia were included in the study. The patients were divided into two groups as Group ESPB (n=25) and Group SAPB (n=25) with the help of computer randomization program. After induction, a catheter was placed at the T5 level and 30 ml of 0.25% bupivacaine was administered to the patients in the ESPB group prior to the surgery. After induction, a catheter was placed in the superficial fascia of the serratus muscle at the level of the fifth rib and 30 ml of 0.25% bupivacaine was administered to the patients in the SAPB group prior to the surgery. Patients in both groups were started with patient-controlled analgesia (PCA) and 0.125% bupivacaine infusion from the ESPB and SAPB catheters when the NRS score was ≥3 post-operatively. Intra-operative fentanyl use, NRS scores of both groups in the first 24 hours post-operatively, use of morphine as rescue analgesia, PCA attachment time, and complications were recorded. Intra-operative fentanyl consumption was found to be significantly lower in the ESPB group (p<0.05). When the two groups were compared in terms of PCA binding time, no statistically significant difference was found (p>0.05). In both groups, post-operative NRS scores decreased over time with rest and cough (p<0.05). There was no significant difference between the two groups for the post-operative NRS scores and the use of rescue analgesia (p>0.05). No complications were observed during the procedure in either group. Our study shows that ESPB is more effective than SAPB in intraoperative analgesia management, and both blocks provide analgesia with similar effectiveness in postoperative analgesia management. Keywords: Post-operative analgesia management; patient-controlled erector spinae plane block; patient-controlled superficial serratus anterior plane block; video-assisted thoracoscopic surgery.