Erector spinae plane block versus combined erector spinae plane block and serratus anterior plane blocks for post-thoracotomy pain: a double-blinded randomized study

BACKGROUND: Thoracotomy is one of the major surgical procedures causing severe postoperative pain. Different regional analgesia techniques can be performed as part of a multimodal analgesia regimen. METHODS: Sixty patients were prospectively enrolled and randomly allocated into two groups (N.=30 each): one group in which both the erector spinae plane block (ESPB) and the serratus anterior plane block (SAPB) were performed, and another group in which only ESPB was performed. Pain intensity was assessed using the static and dynamic Numeric Rating Scale (NRS) at several postoperative time points (one, two, four, six, 12, 24, 48, and 72 hours). Additionally, postoperative opioid consumption, the need for rescue analgesia, opioid-related side effects, and patient satisfaction were measured. RESULTS: In the ESPB + SAPB combination group, static NRS scores were significantly lower at one, two, four, six and 12 hours postoperatively (P<0.05). Dynamic NRS scores were significantly lower at six hours (P=0.036). Furthermore, opioid consumption was significantly reduced in the ESPB+SAPB group at many time intervals postoperatively and total opioid use was significantly lower (P=0.001). There was no significant difference between the two groups in the requirement for rescue analgesia, patient satisfaction or incidence of opioid-related side effects (P>0.05.). CONCLUSIONS: The combination of ESPB and SAPB may offer improved postoperative analgesia compared to ESPB alone, particularly in the early postoperative period. This approach could be considered as a potentially valuable strategy for optimizing pain management after thoracotomy.