Abstract
BACKGROUND: Video-Assisted Thoracoscopic Surgery (VATS) is a commonly used minimally invasive technique in thoracic surgery. The continuous serratus anterior plane block (cSAPB) involves the placement of a catheter deep in the serratus anterior fascia for the slow and continuous infusion of local anesthetics. Liposomal bupivacaine is a formulation of bupivacaine encapsulated in liposomes, which prolongs the release of the drug. This study compares the impact of cSAPB with bupivacaine and single-shot SAPB with liposomal bupivacaine on postoperative recovery quality and pain control after VATS. METHODS: This study is a Randomized Controlled Trial. Patients were randomly assigned to two groups: one receiving cSAPB with conventional bupivacaine (cSAPB + CB) (n = 35) and the other receiving SAPB with liposomal bupivacaine (SAPB + LB) (n = 35). The primary outcome measure was the Quality of Recovery (QoR-15) scores at 24 and 48 h post-surgery. Secondary outcomes included: pain intensity assessed using the Visual Analog Scale (VAS) pain scale at rest and during deep breathing at 24 and 48 h postoperatively, postoperative pulmonary function, total opioid consumption during and after surgery, and adverse events. RESULTS: QoR-15 scores were significantly elevated in the SAPB + LB group at both 24 and 48 h post-surgery(24 h: p = 0.001; 48 h: p = 0.02). Comparative analysis revealed no statistically significant differences between the SAPB + CB group and the SAPB + LB group in terms of VAS scores for pain at rest at 24 and 48 h (24 h: p = 0.06; 48 h: p = 0.46), or during deep breathing (24 h: p = 0.45; 48 h: p = 0.73). Additionally, there were no significant differences in lung function tests (FEV1/FVC ratio, p = 0.95), total intraoperative opioid consumption (p = 0.76), or total postoperative opioid consumption (p = 0.69). However, the incidence of local complications such as swelling and pain was significantly reduced in the SAPB + LB group (p = 0.03). CONCLUSIONS: The use of single liposomal bupivacaine serratus anterior plane block provides superior early postoperative recovery quality and reduces the incidence of local complications. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier ChiCTR2100054089, June 28,2024.