Continuous erector spinae plane block versus intercostal nerve block in patients undergoing video-assisted thoracoscopic surgery: a pilot randomized controlled trial

Abstract

Background The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade. Methods This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal, body mass index >40 kg/m2, contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines, known allergy to local anesthetics, language or comprehension barriers, procedures with a higher chance of open surgery, and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary). Results Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects. Conclusions A fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions. Trial registration Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017.

Ultrasound-guided, continuous erector spinae plane (ESP) block in minimally invasive thoracic surgery—comparing programmed intermittent bolus (PIB) vs continuous infusion on quality of recovery and postoperative respiratory function: a double-blinded randomised controlled trial

“…Single-shot truncal regional anaesthesia techniques are restricted by the limited duration of analgesia; catheter techniques can offer the potential benefit of prolonged analgesia. Previous studies using catheter techniques for MITS have used the traditional end points of opioid consumption and pain scores to assess efficacy [ 21 ]. The VAS is an imperfect scale without psychometric evaluation that overlooks the individual components of recovery and is prone to overrating [ 15 ].…”

Ultrasound Guided Erector Spinae Plane Catheter Versus Video-Assisted Paravertebral Catheter Placement in Minimally Invasive Thoracic Surgery: Comparing Continuous Infusion Analgesic Techniques on Early Quality of Recovery, Respiratory Function and Chronic Persistent Surgical Pain: Study Protocol for A Double-Blinded Randomised Controlled Trial.

“…The use of catheter techniques for MITS are not well documented and existing pilot feasibility trials have used the traditional end points of opioid consumption and pain scores to assess its e cacy. 22 To the best of our knowledge, no trial to date has examined the impact ESP catheters on quality of recovery in MITS patients.…”

The Effect of Ultrasound-Guided Erector Spinae Plane Block versus Thoracic Epidural Block on Postoperative Analgesia After Nuss Surgery in Paediatric Patients: Study Protocol of a Randomized Non-Inferiority Design Trial

“…17 The preliminary results of ESPB in terms of analgesic effects are promising. [34][35][36][37] However, there have been limited studies of its clinical efficacy compared with the traditional gold standard of TEA in paediatric patients undergoing Nuss surgery.…”