Effect of adding preoperative serratus anterior plane block to intercostal nerve block with liposomal bupivacaine on postoperative pain in patients undergoing video-assisted thoracoscopic lung resection: study protocol for a prospective randomized controlled trial

BackgroundEffective postoperative pain management is fundamental to enhanced recovery after video-assisted thoracoscopic surgery (VATS). Previous studies have demonstrated that both serratus anterior plane block (SAPB) and intercostal nerve block (ICNB) effectively alleviate postoperative pain. However, data on the combination of these two techniques using liposomal bupivacaine, a sustained-release local anesthetic formulation, remain limited. Accordingly, this randomized controlled trial aims to compare the postoperative analgesic efficacy of combined preoperative SAPB and intraoperative ICNB vs. sham SAPB plus active ICNB in patients undergoing VATS lung resection, with liposomal bupivacaine administered for both blocks.MethodsThis single-center randomized controlled trial will enroll 98 patients scheduled for video-assisted thoracoscopic lung resection to compare the postoperative analgesic efficacy of combined preoperative SAPB and intraoperative ICNB vs. sham SAPB plus intraoperative ICNB, with liposomal bupivacaine administered for both nerve blocks. The primary outcome is the VAS (0–10) pain score with movement at 24 h postoperatively; secondary outcomes include cumulative sufentanil consumption within 48 h and the number of patient-controlled intravenous analgesia (PCIA) demands.DiscussionThis trial will provide the first head-to-head evidence comparing the analgesic efficacy of combined SAPB and ICNB vs. sham SAPB plus ICNB using liposomal bupivacaine in VATS lung resection. If the combination strategy demonstrates superior analgesic efficacy, it may establish a more effective multimodal analgesic regimen for postoperative pain management in thoracic surgery. These findings are expected to inform clinical practice and guide the development of future perioperative analgesic protocols.Clinical Trial Registration:https://www.chictr.org.cn/showproj.html?proj=295245, identifier ChiCTR2500112224.