Impact of continuous serratus plane analgesia on quality of recovery after video-assisted thoracic surgery: a prospective double-blind, randomized, placebo-controlled trial

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) offers numerous advantages over open surgery; nevertheless, it remains associated with significant postoperative pain. Multiple regional anesthesia techniques have been explored, and the serratus anterior plane block (SAPB) has emerged as a promising option; however, evidence on the use of continuous SAPB infusion for quality of recovery (QoR-40) remains limited. We hypothesized that continuous SAPB infusion, combined with multimodal analgesia, could improve QoR-40 after VATS. METHODS: In this prospective, double-blind, randomized controlled trial, adults undergoing elective VATS received an infusion of either 0.2% ropivacaine or saline via a SAPB catheter, in addition to standardized multimodal analgesia. The primary outcome was the QoR-40 score on postoperative day (POD) 1. Secondary outcomes included QoR-40 scores on POD 2-4, pain scores, opioid consumption in intravenous morphine milligram equivalents (IV MME), length of hospital stay (LOS), complications, and 30-day readmission. RESULTS: A total of 173 patients were analyzed (SAPB: n=88; control: n=85). Median QoR-40 scores on POD 1 were higher in the SAPB group (176 (166-184) vs 172 (159-183); p=0.1036), and remained higher across POD 2 to 4, although not statistically significant. SAPB significantly reduced opioid consumption in recovery (8.0±7.4 vs 10.6±9.3 IV MME; p=0.0388) and on POD 1 (12.73±10.75 vs 16.45±12.17 IV MME; p=0.0349). LOS was also lower but not statistically significant by 0.8 days (2.69±1.76 vs 3.50±4.01; p=0.0872). Pain scores, complications, and 30-day readmissions were similar between groups. CONCLUSIONS: In this prospective, double-blind, randomized, placebo-controlled trial, continuous SAPB catheter infusion did not improve the primary outcome (QoR-40), and the observed differences in secondary outcomes should be interpreted as exploratory. Larger studies are needed to confirm effects on patient-reported recovery.