Abstract
Aims: The
serratus anterior plane block (SAPB)
has commonly been utilized as a regional anesthesia technique for pain
management in various upper chest surgical procedures. The purpose of
this study was to investigate the analgesic effect and pharmacokinetics
of ropivacaine in continuous SAPB undergoing video-assisted
thoracoscopic surgery (VATS).
Methods: This prospective
randomized study included patients
scheduled for elective VATS. Patients first received a bolus of 20 ml of
0.2% (Group L) or 0.375% (Group H) ropivacaine that was administered
beneath the serratus anterior muscle. The pump was connected to the
catheter for continuous administration within 48 hours postoperatively,
in which a background infusion at a rate of 7 ml·h−1of low-dose at 0.2% (Group L) or high-dose at 0.375% (Group H) of
ropivacaine was administered. The main results were to compare the
analgesic effects and analyze the pharmacokinetics of different
concentrations of ropivacaine.
Results: Eighty-eight patients agreed to participate in the
trial and were recruited. The VAS scores in Group H at 12, 24, and 48
hours postoperatively at rest and on coughing were significantly lower
than those in Group L. The peak
values of total ropivacaine plasma concentrations were observed at 48
hours (2.01 μg·mL−1 for Group L and 2.93
μg·mL−1 for Group
H), which were far below the theoretical toxicity threshold.
Postoperative rescue analgesia, complications, and other outcomes did
not differ significantly.
Conclusions: In VATS patients, the analgesic effect of 0.2%
ropivacaine for continuous SAPB was not inferior to that of 0.375%
ropivacaine, and the blood concentration of 0.2% ropivacaine was lower.
The trial was registered in the Chinese Clinical Trial Registry
(ChiCTR2100053517).