Comparison of Analgesic Effect and Postoperative Recovery of SAPB Combined With ESPB and TPB After Thoracoscopic Surgery

Study Overview
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Brief Summary
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After thoracoscopic surgery, patients still face moderate to severe pain. How to effectively control pain and promote postoperative recovery of patients is a challenging problem. Thoracic paraspinal block is effective in controlling pain after thoracoscopic surgery, but it also carries the risk of difficulty in operation and puncture of the pleura. In recent years, erector spinal plane block and serratus anterior plane block have been used for postoperative analgesia after thoracoscopic surgery. The purpose of this study was to explore whether erector spinal plane combined with serratus anterior plane block can replace thoracic paravertebral block and provide a more complete analgesia after thoracoscopic surgery. Therefore, this study is of great clinical significance.

Detailed Description
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In a double-blind randomized controlled study, investigators allocated 92 patients undergoing VATS to either SAPB Combined With ESPB or TPB, with both groups receiving otherwise standardized treatment, including multimodal analgesia. The primary outcome was 24-hr opioid consumption. Secondary outcomes included the number of survival analgesia at 1, 2, 4, 8, and 24 hours postoperatively ,VAS scores was assessed during resting and coughing statuses at 1, 2, 4, 8, and 24 hours postoperatively, pulmonary function indexes before and 1, 4, 24 hours after surgery , QOR-15 scores before and 24 hours after surgery, postoperative complications and recovery time nodes drainage tube removal time, discharge time.

Official Title
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Comparison of Analgesic Effect and Postoperative Recovery of Serratus Anterior Plane Block Combined With Erector Spinae Plane Block and Thoracic Paravertebral Block After Thoracoscopic Surgery

Conditions
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Thoracoscopic Surgery, Nerve Block

Intervention / Treatment
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* Procedure: erector spinal plane combined with serratus anterior plane block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American ASA Grade I-III; Age: 18   70 years old; 3 BMI 19   28kg/m2; 4. Patients with elective thoracoscopic partial pneumonectomy under general anesthesia; 5 Informed Consent has been signed. Exclusion Criteria: Use opioid analgesics on a daily basis or have a history of opioid abuse; History of ipsilateral thoracotomy; Allergic to any of the drugs used in the study, or have a history of drug allergy; Mental or nervous system diseases, motor or sensory deficits; 5 there is coagulation dysfunction; 6. Cognitive dysfunction, unable to cooperate with research; 7. Severe renal, hepatic or cardiac dysfunction; 8. Chest wall and spine trauma, infection, deformity and other cases where nerve block cannot be performed; 9. Participated in other clinical trials within the 3 months prior to study inclusion; 10. Investigators consider other reasons unsuitable for clinical trial participants; 11. Patients refuse to participate.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ESPB&SAPB<br>erector spinal plane block combined with serratus anterior plane block | Procedure: erector spinal plane combined with serratus anterior plane block<br>* The experimental group received ultrasound-guided erector spinal block combined with serratus anterior plane block, and erector spinal block was performed at the T5 and T7 levels with 10ml 0.4% ropivacaine for each level, and 20ml 0.4% ropivacaine for serratus anterior plane block. The control group received ultrasound-guided thoracic paravertebral block at T5 and T7 levels, respectively, with 20ml 0.4% ropivacaine at each level.<br>* Other names: thoracic paravertebral block;|
| Active Comparator: TPVB<br>thoracic paravertebral block | Procedure: erector spinal plane combined with serratus anterior plane block<br>* The experimental group received ultrasound-guided erector spinal block combined with serratus anterior plane block, and erector spinal block was performed at the T5 and T7 levels with 10ml 0.4% ropivacaine for each level, and 20ml 0.4% ropivacaine for serratus anterior plane block. The control group received ultrasound-guided thoracic paravertebral block at T5 and T7 levels, respectively, with 20ml 0.4% ropivacaine at each level.<br>* Other names: thoracic paravertebral block;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The dose of opioids used | dosage of analgesic pump | 24 hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The dose of opioids used | dosage of analgesic pump | 1hour, 2hours, 4hours, 8hours and 48hours postoperatively after surgery | 
| The number of survival analgesia | times of rescue analgesia | 1hour, 2hours, 4hours, 8hours, 24hours and 48hours after surgery | 
| VAS scores at resting and coughing state | visual analog pain scale | 1hour, 2hours, 4hours, 8hours, 24hours and 48hours after surgery | 
| pulmonary function indexes | FVC (L) | Preoperative, postoperative 1hour, postoperative 4hours and postoperative 24hours | 
| QOR-15 scores | The highest score is 150,the lowest score is 0. The higher the score, the better off the patient was. | before and 24 hours after surgery | 
| Postoperative complications and recovery time nodes | drainage tube removal time, length of stay, etc. | follow up patients for an average of half a month |