BACKGROUND The efficacy of serratus anterior plane block for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of serratus anterior plane block on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection. METHODS Patients undergoing minimally invasive anatomic lung resection at a single center were randomized to undergo serratus anterior plane block with 40 ml injectate containing bupivacaine 0.25%, clonidine 100 μg, and dexamethasone 4 mg (serratus anterior plane block group) or sham block with 40 ml normal saline (placebo group) at the conclusion of surgery. The primary outcome was cumulative intravenous morphine equivalents during the first 24 h postoperatively. Secondary outcomes were intravenous morphine equivalents, pain scores at rest and with cough, inspiratory volume on incentive spirometry, incidence of nausea or vomiting during the first 48 h postoperatively, Quality of Recovery-15 score on postoperative day 7, and length of stay. RESULTS Using the protocol-specified intention-to-treat analysis, the median (interquartile range) intravenous morphine equivalents was 10.6 (5.0 to 27.1) mg in serratus anterior plane block patients (n = 46) versus 18.8 (9.9 to 29.6) mg in placebo patients (n = 46; 32% reduction; ratio, 0.68 [95% CI, 0.44 to 1.06]; P = 0.085). Of the secondary outcomes, only the composite pain with cough scores differed significantly in the serratus anterior plane block group by a coefficient of -0.41 (95% CI, -0.81 to -0.01; P = 0.044). A sensitivity as-treated analysis reported median (interquartile range) intravenous morphine equivalents of 10.0 (5.0 to 27.2) mg in serratus anterior plane block patients (n = 44) versus 19.9 (10.4 to 29.0) mg in placebo patients (n = 48; 36% reduction; ratio, 0.64 [95% CI, 0.41 to 1.00]; P = 0.048). CONCLUSIONS The protocol-specified intention-to-treat analysis demonstrated that serratus anterior plane block did not result in a significant reduction in opioid consumption when added to a multimodal analgesic regimen after thoracoscopic anatomic lung resection. The sensitivity as-treated analysis showed a significant and modest clinical reduction in the primary outcome that warrants further investigation. EDITOR’S PERSPECTIVE

中文翻译：

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前锯肌平面阻滞对胸腔镜肺切除术早期恢复的影响：一项随机、盲法、安慰剂对照试验。


背景 前锯肌平面阻滞治疗微创胸外科手术后疼痛的疗效尚不清楚。该试验评估了前锯肌平面阻滞对术后阿片类药物消耗和胸腔镜肺切除术后早期恢复措施的影响。方法 在单中心接受微创解剖肺切除术的患者随机接受前锯平面阻滞，注射液 40 ml，注射液含 0.25 年布比卡因、可乐定 100 μg 和地塞米松 4 mg（前锯肌平面阻滞组）或假阻滞，含 40 ml 生理盐水（安慰剂组）手术结束时。主要结局是术后前 24 小时内累积静脉注射吗啡当量。次要结局是静脉注射吗啡当量、静息和咳嗽时疼痛评分、诱发性肺活量测定的吸气量、术后前 48 小时内恶心或呕吐的发生率、术后第 7 天的恢复质量 15 评分和住院时间。结果使用方案规定的意向性治疗分析，前锯肌平面阻滞患者 （n = 46） 的中位（四分位距）静脉注射吗啡当量为 10.6 （5.0 至 27.1） mg，而安慰剂患者为 18.8 （9.9 至 29.6） mg （n = 46;减少 32%;比率，0.68 [95% CI，0.44 至 1.06];P = 0.085）。在次要结局中，只有前锯肌平面阻滞组的复合疼痛与咳嗽评分显著差异系数为 -0.41 （95% CI，-0.81 至 -0.01;P = 0.044）。一项敏感性治疗分析报告称，前锯肌平面阻滞患者 （n = 44） 的中位（四分位距）静脉注射吗啡当量为 10.0 （5.0 至 27.2） mg，而 19.9 （10.4 至 29）。安慰剂患者为 0） mg（n = 48;减少 36%;比率，0.64 [95% CI，0.41 至 1.00];P = 0.048）。结论方案规定的意向性治疗分析表明，在胸腔镜解剖肺切除术后添加到多模式镇痛方案中时，前锯肌平面阻滞不会导致阿片类药物消耗的显着减少。治疗后的敏感性分析显示，主要结局的临床水平显著降低，值得进一步研究。编辑观点