Erector Spinae Plane Block Versus Serratus Anterior Plane Block for Analgesia After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial

Background: The comparative efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) for analgesia after video-assisted thoracoscopic surgery (VATS) remains ambiguous. Objectives: This study aimed to compare the analgesic efficacy of ESPB and SAPB after VATS. Methods: In this prospective, randomized, open-label, blinded-endpoint (PROBE) trial, forty patients undergoing VATS were randomized to receive preoperative ultrasound-guided ESPB (n = 20) or SAPB (n = 20) with 30 mL of 0.25% bupivacaine. Ultrasound imaging confirmed local anesthetic dispersion. The primary outcome was total meperidine consumption in the first 24 hours postoperatively. Secondary outcomes included intraoperative fentanyl consumption and postoperative pain scores (Numerical Rating Scale (NRS) and Visual Analog Scale (VAS)). Results: The ESPB group required significantly less intraoperative fentanyl (median 50 µg vs. 80 µg, P < 0.001). Pain scores were significantly lower in the ESPB group at 2, 4, and 8 hours (NRS and VAS, all P < 0.05). Total 24-hour meperidine consumption was significantly lower in the ESPB group (40 mg vs. 80 mg, P < 0.001). No significant differences were observed in adverse events. Conclusions: Erector spinae plane block provided superior analgesia compared to SAPB in patients undergoing VATS, as evidenced by reduced opioid consumption and lower pain scores. These findings support ESPB as an effective regional analgesic technique in VATS patients, warranting validation in larger, blinded, multicenter trials.