Comparisonof The Analgesic Efficacy Of Ultrasound-guided Rhomboid Intercostal And Sub-serratus Plane Block And Thoracic Paravertebral Nerve Block For Thoracocopic Surgery

Objective: To investigate the non-inferiority effect of ultrasond-guided rhomboid intercostal and sub-serratus(RISS)block and thoracic paravertebral nerve block(TPVB)in postoperative analgesia after thoracoscopic surgery.Methods: Fifty patients aged ≥18 years who underwent selective thoracoscopic surgery from October 2022 to February 2023 were included and randomly divided into RISS group(n=25)and TPVB group(n=25)with ASA gradeⅠtoⅢ.Vital signs were monitored and basic values were calculated after entering the operating room.After general anesthesia,the patient was placed in the lateral position as required,patients in RISS group were given0.25% ropivacaine 40 ml and patients in TPVB group were given 0.33% ropivacaine30 ml.Patient-controlled intravenous analgesia(PCIA)was used after surgery.Time of block operation,Intraoperative dosage of sufentanil and remifentanil,VAS scores of resting and cough at 1,2,4,8,24,48 h after surgery,Total consumption of intravenous analgesia at 4,8,24,48 h after surgery,First time to get out of bed,Postoperative adverse reactions and complications,Patient satisfaction were recorded.Results: There were no significant differences in gender,age,BMI,ASA,anesthesia or operation time,operation type and other general conditions between the two groups(P >0.05).There were no significant differences in the scores of resting and coughing VAS between the two groups(P>0.05),and the mean difference of resting VAS score 95%CI did not exceed the non-inferiority margin.Comparison of total consumption of intravenous analgesics at different time points during and after operation between the two groups,there was no statistical difference(P>0.05),and there were no significant differences in the first time of getting out of bed and satisfaction between the two groups(P<0.05).Compared with TPVB group,the operation time of RISS group(259.43±30.11s)was lower than that of TPVB group(335.23±30.96s)(P<0.001),the number of patients with hypotension in RISS group(2 cases)was lower than that in TPVB group(7 cases)(P=0.022).Conclusion:In thoracoscopic surgery,the analgesic effect of ultrasond-guided rhomboid intercostal and sub-serratus block is no worse than that of thoracic paravertebral space block.By comparison,the operation of ultrasond-guided rhomboid intercostal and sub-serratus block is simple and fast,and in this gruop,the complications related to puncture are less,and the hemodynamics of patients are less affected.