Résumé
Introduction: the new “Bi-bloc” technique, combining a serratus anterior plane block (SAP) and an erector spinae plane block (ESP), was compared to the thoracic epidural analgesia (TEA) in patients undergoing video-assisted thoracic surgery (VATS). Methods: in a single-centre retrospective cohort study, were eligible patients scheduled for VATS with either a Bi-bloc or an epidural in the Montpellier University Hospital. Each patient “Bi-bloc” was matched on age, gender, and type of surgery with two TEA patients.The primary endpoint was the cumulative dose of Morphine received during 48 hours post-operatively. According to a non-inferiority hypothesis, the margin was set at 20 mg of Morphine over 48 hours. Results: between january 2017 and december 2019, 30 patients were included in the Bi-bloc group and 60 in the TEA group. Morphine consumption during 48 h was (mean ±SD) 7 ± 10 mg in the Bi-bloc group vs 1 ± 2 mg in the TEA group (P < 0.01).The difference of Morphine consumption between the two groups was 6 mg (95%CI 3—10), below the non-inferiority threshold.The Bi-bloc had other qualities related to enhanced recovery: urinary retention and nausea or vomiting were less frequent, and the length of stay in PACU was shorter. Conclusion: the thoracic Bi-bloc was non-inferior to TEA regarding postoperative analgesia after VATS.This new technique seems to be associated with better enhanced recovery outcomes.