Effect of Combined Deep and Superficial Serratus Anterior Plane Block Versus Deep Serratus Anterior Plane Block on Postoperative Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Randomized Trial

Objectives: This study aimed to compare the analgesic efficacy of a combined deep and superficial serratus anterior plane block (SAPB) with deep SAPB alone in patients undergoing video-assisted thoracoscopic surgery (VATS). Design: A prospective, randomized clinical trial. Setting: Single-center, academic hospital. Participants: Sixty patients undergoing elective VATS. Interventions: One group received a combined deep and superficial SAPB (each 15 mL of 0.375% bupivacaine with epinephrine 5 µg/mL injected both deep to and above the serratus anterior muscle) (group DS), while the other group received 30 mL of the same solution deep into the serratus anterior muscle only (group D). Additionally, 5 mL of 0.25% bupivacaine was infiltrated at the chest tube insertion site in all patients. Standardized multimodal analgesia included intravenous morphine (0.1 mg/kg), paracetamol (1,000 mg), and ibuprofen (800 mg), administered 30 minutes before the end of surgery. Postoperative analgesia was maintained with intravenous patient-controlled fentanyl. Measurements and Main Results: Demographic and operative characteristics were comparable between the groups. Total postoperative opioid consumption within 24 hours, expressed in morphine milligram equivalents, was 27.12 ± 16.67 mg in group D and 32.84 ± 19.86 mg in group DS, with no significant difference between groups (p = 0.137). The total amount of rescue analgesia was 11.67 ± 11.47 mg in group D and 16.33 ± 12.45 mg in group DS, with no statistically significant difference between the groups (p = 0.141). Postoperative pain scores and the incidence of opioid-related adverse effects were similar between groups (p > 0.05 for all). Conclusions: This study demonstrates that a single deep SAPB provides equivalent postoperative analgesia to combined single and deep SAPB. Both techniques offered comparable postoperative analgesia and safety profiles.