Yang Zhang,1,* Wei Li,1,2,* Aiping Wei,1,* Shibiao Chen,1 Xiuhong Wang1 

1Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China; 2Department of Anesthesiology, Shenzhen People’s Hospital, Shenzhen, Guangdong, 518000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shibiao Chen, Email Chenlaoshi1111@163.com Xiuhong Wang, Email wangxh19871227@163.com

Background: The optimal analgesic regimen after video-assisted thoracoscopic surgery (VATS) is unclear. We aimed to examine whether ultrasound-guided serratus anterior plane block (SAPB) with liposomal bupivacaine could provide continuous and effective analgesic effects for lung cancer patients undergoing VATS.
Methods: A total of 64 patients were randomly allocated to receive either the liposomal bupivacaine (LB group) or the ropivacaine (RO group). The primary outcome was pain score at rest and on movement in the first three days after surgery. The secondary outcomes included intraoperative remifentanil consumption, perioperative consumption of sufentanil and flurbiprofen axetil, time to extubation, time to first bowel movement, time to first flatus, incidence of postoperative nausea and vomiting (PONV), length of intensive care unit (ICU) stay, length of hospital stay, hospitalization costs, and early recovery quality as assessed by QoR-15 score.
Results: The LB group had significantly lower pain scores at rest and on movement at 12h, 24h, 36h, 48h, and 72h after surgery, and lower pain scores on movement at 8h after surgery, when compared with the RO group. Perioperative sufentanil consumption and postoperative flurbiprofen axetil consumption were significantly reduced in the LB group than in the RO group. In addition, compared with the RO group, the LB group had earlier first flatus, mobilization, and urinary catheter removal, shorter ICU stay, lower incidence of PONV, and lower hospitalization costs. The QoR-15 scores in the first three days after surgery were significantly higher in the LB group than in the RO group. There were no statistically significant differences between the two groups regarding time to extubation, intraoperative remifentanil consumption, and length of hospital stay.
Conclusion: Ultrasound-guided SAPB with liposomal bupivacaine was effective in relieving postoperative pain for three days after surgery in patients undergoing VATS.

Keywords: serratus anterior plane block, video-assisted thoracoscopic surgery, liposomal bupivacaine, ropivacaine, postoperative pain