Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Abstract

Background and objectivesThe anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS).MethodIn this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively.ResultsEighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0–1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036).ConclusionsThe analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.Trial registration numberUMIN000030658.

Ultrasound-guided single erector spinae plane block versus thoracic paravertebral block for patients undergoing video-assisted thoracoscopic lobectomy: a single center randomized controlled trial

“…There was no case of local anesthetic intoxation occurred in ESPB group in our study, after all, high volume and high concentration of ropivacaine increased the risk of local anesthesia toxicity [14,17].…”

“…This prospective randomized study showed that a single ESPB provided superior postoperative analgesia than the TPVB in patients undergoing video-assisted thoracoscopic lobectomy, which was different from recent studies. The other three studies all have proved that the analgesic effect of ESPB block is equal to or weaker than that of TPVB [14][15][16].…”

“…According to the preliminary study (n=10, unpublished data), the mean VAS scores after ESPB and TPVB was 2.1 and 3.6, respectively, and the SD of the VAS scores was 1.6. We defined an acceptable superiority margin as 1, according to the previous study [14]. A sample size of 7 in each group was required to provide a power of 0.8 and a one-sided α of 0.05, given the possibility of missed follow-up rate 10%.…”

Ultrasound-Guided Erector Spinae Plane Block Versus Thoracic Paravertebral Block on Postoperative Analgesia After Laparoscopic Nephroureterectomy: Study Protocol of A Randomized, Double Blinded, Non-Inferiority Design Trial

“…Erector spinae plane block (ESPB) is a novel inter-fascial plane block rst introduced by Forero et al in 2016 [6], providing wide-ranging analgesia in lung surgery [7][8][9], laparoscopy [10], mastectomy [11] and pediatric surgery [12,13]. The proposed mechanism of ESPB is that distribution of local anesthetic solution spreads into the paravertebral space and epidural space [14], which then blocks the dorsal, ventral, and tra c branches of spinal nerve.…”

“…Paravertebral block is deemed as a premium alternative to epidural block, has been used for many years in various kinds of surgery due to its de nite analgesia [31]. Most of the recent studies have compared ESPB with intravenous analgesia, however, there is still lack of study comparing ESPB with TPVB except Taketa and colleagues' work [32]. What's more, the mechanism by which ESPB works through paravertebral space remains con icting [15].…”