Effect of bilateral low serratus anterior plane block on quality of recovery after trans-subxiphoid robotic thymectomy: Results of a randomized placebo-controlled trial

Scientific literature about pain management for patients undergoing trans-subxiphoid robotic thymectomy (TRT) remains limited. This randomized placebo-controlled trial aimed to investigate the impact of ultrasound-guided, bilateral, low level (T8-T9) deep serratus anterior plane (DSAP) blocks on postoperative recovery quality and postoperative analgesia in patients undergoing TRT. 39 patients undergoing TRT were randomized to receive either low DSAP blocks (T8-T9) with 20 ml 0.375% ropivacaine under general anesthesia (Group S) or the sham block with 0.9% normal saline (Group C) on each side. The primary outcome was the global Quality of Recovery-40 (QoR-40) score at 24 hours after surgery. Secondary outcomes included numeric rating scale (NRS) scores over time, postoperative 48 hours opioid consumption, QoR-40 scores at 48 hours, 30 days and 90 days after surgery. The QoR-40 scores on POD1-2 were higher among Group S compared with those in Group C [179.1 (4.9) vs 167.7 (2.8), P < 0.01; 187.7 (4.6) vs 178.1 (3), P < 0.01, respectively]. Pain scores were significantly lower in Group S than in Group C, both during resting and motion at postoperative 6h, 12h, and 24h (P < 0.05 for each). The total amount of sufentanil consumed in the first 48 h was lower in Group S than in Group C [61.4 (4.9) vs 78.9 (4.6), P < 0.001]. The bilateral low DSAP blocks with ropivacaine enhanced the quality of recovery for 2 days postoperatively, relieved postsurgical pain, and reduced opioid consumption during the early postoperative period in patients undergoing TRT.