Comparison of Continuous Serratus Anterior Plane Block (cSAPB) with Bupivacaine Versus Single Liposomal Bupivacaine Block in Postoperative Analgesia after Video-Assisted Thoracoscopic Surgery (VATS) ： A Randomised Controlled Trial

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 Patients were randomly assigned to two groups: one receiving cSAPB with conventional bupivacaine (cSAPB + CB) and the other receiving SAPB with liposomal bupivacaine (SAPB + LB). The primary outcome measure was the Quality of Recovery (QoR-15) scores at 24 and 48 hours 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 hours 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 hours post-surgery(24h: p = 0.001; 48h: 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 hours (24h: p = 0.06; 48h: p = 0.46), or during deep breathing (24h: p = 0.45; 48h: 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.