Effect of serratus anterior plane block combined with oxycodone for transition analgesia on preventing emergence agitation after video-assisted thoracoscopic surgery: a randomized controlled trial

Emergence agitation (EA) is more commonly observed after thoracic surgeries and can lead to serious complications. This study aimed to evaluate the effectiveness of serratus anterior plane block (SAPB) combined with oxycodone for transitional analgesia in preventing EA after video-assisted thoracoscopic surgery (VATS). A total of 121 adult patients scheduled for VATS under one-lung ventilation anesthesia were enrolled and randomly divided into three groups: preoperative SAPB without opioids for transitional analgesia near the end of the surgery (SAPB + SAL group, n = 39); preoperative SAPB with sufentanil at 0.1 µg/kg for transitional analgesia (SAPB + SF group, n = 42); and preoperative SAPB with oxycodone at 0.1 mg/kg for transitional analgesia (SAPB + OCD group, n = 40). In primary outcomes, the incidences of EA in the SAPB + SAL, SAPB + SF, and SAPB + OCD groups were 38.5%, 28.6%, and 7.5% respectively. There was a statistically significant difference in EA incidence between the SAPB + OCD and SAPB + SF groups (P = 0.0136). In secondary outcomes, compared to the SAPB + SF group, the SAPB + OCD group experienced shorter tracheal extubation time [15(9, 25) min vs. 21.5(14.5, 32.5) min; P = 0.0473] and PACU stay [67.5(55.0, 85.0) min vs. 87.5(70.0, 110.0) min; P = 0.0026]; lower NRS scores at 15 min and 2 h post-extubation (P < 0.01), and higher Quality of Recovery-15 (QoR-15) scores post-surgery [113(98, 123) vs. 102(88, 112); P = 0.0122]. Our results suggest SAPB combined with oxycodone for transitional analgesia, compared with sufentanil, is more effective in preventing EA after VATS and conductive to rapid recovery postoperatively.Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2300077473, Date: 09/11/2023.