Comparison of the analgesic efficacy of erector spinae plane block, serratus anterior plane block, and serratus posterior superior ıntercostal plane block on postoperative pain in patients undergoing video-assisted thoracoscopic surgery

Background: This study aimed to compare erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and serratus posterior superior intercostal plane block (SPSIPB) to determine the most suitable technique for maintaining postoperative analgesia in video-assisted thoracoscopic surgeries (VATS). Materials and Methods: Forty-five adult patients scheduled for elective VATS were included. Patients were randomly allocated into three groups: ESPB, SAPB, and SPSIPB. All patients received postoperative paracetamol and dexketoprofen, and intravenous tramadol hydrochloride. Postoperative static and dynamic visual analogue scale (VAS) scores, total tramadol consumption, side effects were recorded at regular intervals. Results: Static VAS scores at 0, 1, 6, 12, and 18 hours were significantly higher in the ESPB group than in the SAPB and SPSIPB groups ( P < 0.05). In the SAPB group, static and dynamic VAS scores at 0 and 1 hour were lower compared to the SPSIPB group ( P < 0.05). During the first 24 postoperative hours, tramadol consumption was significantly higher in the ESPB group compared to the other two groups ( P < 0.05). No significant difference in tramadol consumption was observed between the SAPB and SPSIPB groups ( P > 0.05). Conclusion: In patients undergoing VATS, SAPB was associated with lower VAS scores compared to both ESPB and SPSIPB, while ESPB resulted in higher VAS scores and greater tramadol consumption than the other two groups. These findings suggest that SAPB may be a more effective analgesic technique following thoracoscopic surgery, though confirmation with larger patient populations is recommended.