Ultrasound-guided Serratus Anterior Plane Block Versus Paravertebral Block for Postoperative Analgesia in Children Undergoing Video-assisted Thoracoscopic Surgery: A Randomized, Comparative Study

Objectives: This study compared the postoperative analgesic efficacy of serratus anterior plane block (SAPB) and thoracic paravertebral block (PVB) in children undergoing video-assisted thoracoscopic surgery.

Setting: Operating room and intensive care unit of a tertiary care hospital.

Design: A single-center, randomized, comparative, open-labeled study.

Participants: Seventy pediatric patients aged 2 to 10 years who underwent video-assisted thoracoscopic surgery were enrolled.

Interventions: Patients were equally randomized into 2 groups. In the SAPB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the deep SAPB and in the PVB group, patients were injected with 0.4 mL/kg 0.25% bupivacaine under ultrasound guidance into the thoracic paravertebral space.

Measurements and main results: The primary outcome was morphine consumption within the first 24 hours after surgery. The secondary outcomes were Children's Hospital of Eastern Ontario Pain Scale pain score, intraoperative fentanyl consumption, and the time required to perform the block. The median (Q1, Q3) morphine consumption (mg/kg) in the first postoperative 24 hours was similar in the SAPB and PVB groups (0.15 [0.1-0.2], 0.1 [0.1-0.2], respectively). The Children's Hospital of Eastern Ontario Pain Scale pain score was similar in both the SAPB and PVB groups at all-time points. Intraoperative fentanyl consumption was comparable in both groups. Time needed to perform the block was shorter in SAPB than PVB.

Conclusions: SAPB provides effective postoperative pain control, similar to thoracic PVB. Moreover, it is technically easier and has a shorter time to perform than PVB. Therefore, SAPB is an effective and safe alternative to thoracic PVB.