Ultrasound-guided bilateral serratus plane block versus thoracic paravertebral block following minimally invasive pectus excavatum repair in children: A randomized controlled non-inferiority study.

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-08 DOI:10.1016/j.jclinane.2025.112003

Yi He MD, PhD , Mingzhe Xu MD , Zhi Li MD , Jiaqi Yu , Qian Li MD, PhD , Yunxia Zuo MD, PhD , Yi Kang MD , Bin Du MD

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引用次数: 0

Abstract

Study objective

This study evaluated whether ultrasound-guided serratus anterior plane block (SAPB) provided non-inferior analgesic effects for minimally invasive pectus excavatum repair surgery compared with thoracic paravertebral block (TPVB).

Design

A noninferiority randomized trial.

Setting

West China Hospital of Sichuan University.

Patients

Seventy-four children aged 7–16 years who underwent minimally invasive pectus excavatum repair surgery were enrolled.

Intervention

Patients were randomly assigned to receive bilateral SAPB (n = 37) or TPVB (n = 37) after induction of anesthesia (0.5 mL kg⁻¹ 0.25 % of ropivacaine per side).

Measurements

Pain scores assessed via numerical rating scale (NRS) postoperatively; opioid consumption, block-related complications; and plasma ropivacaine concentrations were measured.

Main results

Median (IQR) pain scores for SAPB were 1 (1.0–2.0) and 1 (0.5–2.0) for those with TVPB 24 h postoperatively (effect size = 0.027; 95 % confidence interval, −0.42 to 0.47, P = 0.905), meeting the non-inferiority criterion with a pre-specified margin of 0.5. The TPVB group exhibited a greater incidence of hypotension (29.7 % vs. 8.1 %, p = 0.018). The ropivacaine concentrations were lower in the SAPB group at all measured time points (SAPB: 0.44 (0.21), 0.56 (0.23), and 0.66 (0.29) μg mL⁻¹ vs. TPVB: 1.18 (0.39), 1.17 (0.30), and 1.13 (0.26) μg mL⁻¹ at 10, 30, and 60 min post-injection, respectively).

Conclusion

Compared with TPVB, SAPB provides non-inferior analgesia for children undergoing minimally invasive pectus excavatum repair surgery. Moreover, SAPB is associated with less intraoperative hemodynamic instability and lower plasma concentrations, suggesting it is a safe and valid alternative.

Trial registration

Chinese Clinical Trial Registry, identifier: ChiCTR 2,200,056,596.

查看原文本刊更多论文

超声引导下双侧锯肌平面阻滞与儿童微创漏斗胸修复后胸椎旁阻滞：一项随机对照非效性研究。

研究目的评价超声引导下锯肌前平面阻滞（SAPB）与胸椎旁阻滞（TPVB）在微创胸突修补术中的镇痛效果。设计一项非劣效随机试验。单位：四川大学华西医院。74名7-16岁的儿童接受了微创漏斗胸修复手术。干预：患者在诱导麻醉后随机分配接受双侧SAPB （n = 37）或TPVB (n = 37)（每侧0.5 mL kg - 1 0.25%的罗哌卡因）。测量：术后通过数值评定量表（NRS）评定西班牙评分；阿片类药物消费，阻滞相关并发症；测定血浆罗哌卡因浓度。主要结果：术后24 h TVPB患者SAPB疼痛评分中位数（IQR）分别为1（1.0-2.0）和1(0.5 - 2.0)（效应值= 0.027；95%可信区间为- 0.42 ~ 0.47,P = 0.905），符合非劣效性标准，预设差值为0.5。TPVB组低血压发生率更高（29.7% vs. 8.1%, p = 0.018）。注射后10、30、60 min， SAPB组罗哌卡因浓度分别为0.44（0.21）、0.56（0.23）、0.66 (0.29)μ mL−1，TPVB组为1.18（0.39）、1.17（0.30）、1.13 (0.26)μ mL−1。结论SAPB在儿童微创漏斗胸修复术中具有较好的非亚效性镇痛效果。此外，SAPB与较少的术中血流动力学不稳定性和较低的血浆浓度相关，这表明SAPB是一种安全有效的替代方法。试验注册：中国临床试验注册中心，编号：ChiCTR 2,200,056,596。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.