Double Relief: Study evaluates Synergistic Effects of Hydromorphone and Ropivacaine in Thoracoscopic Surgery
Recently published clinical trial aimed to evaluate the efficacy of hydromorphone as an adjunct to ropivacaine in serratus anterior plane block (SAPB) for postoperative analgesia and inflammatory response management in patients undergoing video-assisted thoracoscopic surgery (VATS).
Methodology
Patients aged 20-75 with American Society of Anesthesiologists classification I or II were randomized into three groups: Hydromorphone-Ropivacaine SAPB (HR), Ropivacaine SAPB (R), and control (C). Randomization used Excel-generated integers, ensuring blinding throughout the study. A total of 129 patients were identified, with 120 included in the final analysis. VAS scores were recorded at 2, 6, 12, 24, and 48 hours post-surgery, while inflammatory markers (CRP, IL-6, TNF-α) were measured preoperatively and at 24 and 48 hours post-surgery.
Key Findings
Postoperative Pain Relief: Group HR exhibited significantly lower VAS scores than Group C at all measured intervals, particularly at 6 hours post-surgery, where it scored 2.00 (IQR: 2.00) compared to Group C's 3.00 (IQR: 3.00) (P < 0.001). The HR group showed enhanced pain control throughout the recovery period.
Opioid Consumption: Total opioid consumption and the need for rescue analgesia were significantly reduced in Groups R and HR when compared to Group C. Specifically, HR group had a lower requirement for patient-controlled intravenous analgesia (PCIA) activations (P < 0.001).
Inflammatory Response: The combination of hydromorphone and ropivacaine significantly attenuated postoperative inflammatory markers, with CRP levels being markedly lower in Group HR at 24 and 48 hours compared to Group C (P < 0.001).
Hemodynamic Stability: No significant intraoperative hemodynamic disturbances were attributed to the analgesic techniques, and major postoperative complications were absent.
Limitations
The study was conducted at a single center, potentially limiting the generalizability of findings. Long-term follow-up data was not collected, leaving the long-term effects of the hydromorphone-ropivacaine combination uncertain. Further investigation is needed to compare SAPB with traditional analgesic methods like thoracic epidural analgesia.
Conclusion
The addition of hydromorphone to ropivacaine in SAPB markedly improved postoperative pain management and reduced inflammatory responses in patients undergoing VATS, reinforcing its potential as an effective analgesic strategy. Future research should explore the long-term outcomes and optimal dosing strategies for hydromorphone in SAPB.
Key Points
Analgesic Efficacy: The combination of hydromorphone and ropivacaine in serratus anterior plane block (SAPB) resulted in significantly lower Visual Analog Scale (VAS) pain scores at all assessed time intervals compared to the control group, with the most notable improvement observed at 6 hours post-surgery.
Reduced Opioid Use: Patients receiving the hydromorphone-ropivacaine combination demonstrated a statistically significant reduction in total opioid consumption and need for rescue analgesia, specifically showing fewer activations of patient-controlled intravenous analgesia (PCIA) compared to the control group.
Inflammatory Marker Reduction: The treatment group receiving hydromorphone and ropivacaine showed a marked decrease in inflammatory markers, such as C-reactive protein (CRP), at 24 and 48 hours post-surgery, indicating an enhanced anti-inflammatory response.
Safety Profile: The analgesic techniques employed did not result in significant intraoperative hemodynamic disturbances, and no major postoperative complications were reported, suggesting a favorable safety profile for the combination therapy.
Study Limitations: Generalizability may be constrained as the trial was conducted at a single center, and the absence of long-term follow-up data raises questions about the sustained effects of the hydromorphone-ropivacaine combination.
Future Research Directions: Further studies are recommended to assess long-term outcomes associated with hydromorphone in SAPB and to investigate optimal dosing strategies while potentially comparing SAPB with established analgesic methods such as thoracic epidural analgesia.
Reference –
Xuefeng Chen et al. (2025). The Impact Of Hydromorphone Combined With Ropivacaine In Serratus Anterior Plane Block On Postoperative Pain In Patients Undergoing Video-Assisted Thoracoscopic Pulmonary Lobectomy: A Randomized, Double-Blind Clinical Trial. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03101-2.
