Evaluation of ultrasound-guided erector spinae plane block for postoperative management of video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial

Abstract

Background: Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS. Methods: We performed a prospective, randomized, single-center study between December 2018 and December 2019. Fifty-four patients were recruited to two equal groups (ESPB and control group).Following exclusion, 46 patients were included in the final analysis. Patients were randomly assigned to receive preoperative ultrasound-guided ESPB with either ropivacaine or saline. The primary outcome was the numeric rating scale (NRS) score, assessed 12 hours postoperatively. Secondary outcomes were the Riker Sedation-Agitation Scale (SAS) score for emergence agitation, postoperative cumulative opioid consumption, length of post-anesthesia care unit (PACU) stay, incidence of postoperative nausea and vomiting (PONV) and dizziness, and ESPB-related adverse events. Results: The NRS in the ESPB group during the postoperative period immediately after PACU admission was significantly lower than that in the control group (5.96±1.68 and 7.59±1.18, respectively; P<0.001) and remained lower until 6 hours postoperatively (P=0.001 at 1 hour and P=0.005 at 6 hours). At 12 hours postoperatively, NRS scores were not significantly different between groups (P=0.12). The median [interquartile range (IQR)] of the postoperative rescue pethidine consumption in PACU was significantly lower [25 mg (25 mg)] in the ESPB group than that in the control group [50 mg (56.2 mg); P=0.006]. The median (IQR) of PACU residual time was significantly lower [25 min (10 min)] in the ESPB group than that in the control group [30 min (15 min); P=0.034]. The median (IQR) Riker SAS was also lower in the ESPB group [4 (1.0)] than that in the control group [5 (1.25); P<0.001] in PACU. Conclusions: A single preoperative injection of ESPB with ropivacaine may improve acute postoperative analgesia and emergence agitation in patients undergoing VATS.

Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study

“…VATS is a commonly performed minimally invasive procedure that has helped to reduce levels of pain, but pain remains an issue associated with VATS, especially for the first 3 days after surgery, and it requires analgesia that blocks both visceral and somatic nerve fibres for more effective pain control so as to improve postoperative outcome. 36–38 It has been reported that regional techniques combined with general anaesthesia provide better perioperative analgesia by completing the somatosensorial and sympathetic block and have an opioid analgesic sparing effect. 39 The results of our study suggest that the average NRS score within 48 h postoperatively in group TG was significantly lower than that in group GA ( P <0.05), which is consistent with the results of Qiu et al 40 who found that TPVB provided analgesia that was superior to general anaesthesia alone during the initial 2 h after VATS in a noninferiority randomized trial.…”

The “new kid” on the fascial plane block: erector spinae block – a narrative review

“…14 Post-thoracotomy pain syndrome is a common experience for patients undergoing thoracic surgery and has debilitating consequences associated with inadequate analgesic efficacy. 15 Despite the advantages of the minimally invasive surgical technique, video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy is painful with stimulation of both visceral and somatic nociceptive nerve fibres. 15 The ESP block at the level of the fifth thoracic vertebra (T5) in patients undergoing mini-thoracotomy was evaluated for postoperative analgesic efficacy.…”

“…15 Despite the advantages of the minimally invasive surgical technique, video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy is painful with stimulation of both visceral and somatic nociceptive nerve fibres. 15 The ESP block at the level of the fifth thoracic vertebra (T5) in patients undergoing mini-thoracotomy was evaluated for postoperative analgesic efficacy. 15,16 Reports have shown that patients undergoing a minithoracotomy who receive ESP blocks have lower postoperative pain scores compared to both those who receive intercostal nerve blocks (p < 0.05) 16 and those who receive no regional block (p = 0.005), 15 respectively.…”

“…15 The ESP block at the level of the fifth thoracic vertebra (T5) in patients undergoing mini-thoracotomy was evaluated for postoperative analgesic efficacy. 15,16 Reports have shown that patients undergoing a minithoracotomy who receive ESP blocks have lower postoperative pain scores compared to both those who receive intercostal nerve blocks (p < 0.05) 16 and those who receive no regional block (p = 0.005), 15 respectively. However, it was demonstrated that the TPVB had the greatest analgesic efficacy compared to both intercostal nerve blocks and ESP blocks for a mini-thoracotomy.…”

The analgesic effect of erector spinae plane block in thoracic surgery: a systematic review and meta-analysis of randomized controlled trials

“…Among the included studies, ten studies [12,15,17,18,20,22,[24][25][26][27] and five studies [12,15,[25][26][27] reported postoperative 12 hour pain scores at rest or movement respectively. Pain scores of the ESPB group were significantly lower than those of the control group at rest or movement.…”