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

Abstract

Introduction: Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Attention is increasingly paid to its premium analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy surgery.Methods and analysis: This prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB or TPVB will be performed with an injection of 0.375% ropivacaine 0.4ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24th h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption and pain NRS scores at different preset timepoint within 48h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and flatus, and adverse events, as well as length of stay in hospital and anesthesia cost. Discussion: Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparation between ESPB and TPVB in urological surgery is still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy surgery, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score.Trial registration: Chinese Clinical Trial Registry, ChiCTR 2000031916. Registered on 14 April 2020. http://www.chictr.org.cn/showproj.aspx?proj=50782

Evaluation of Analgesia Effect after Ultrasound-Guided Laparoscopic Renal Surgery

“…Laparoscopy has steadily grown and replaced a number of conventional surgical approaches, giving new assistance for a variety of conditions, thanks to extensive promotion of the idea of minimally invasive surgery. Retroperitoneal laparoscopic radical nephrectomy has become a popular surgical treatment for patients with kidney cancer because of its benefits such as little trauma, good operative vision, and speedy patient recovery [7]. After all, surgery is an intrusive procedure.…”

Comparison of the effects of ultrasound-guided thoracic paravertebral block and erector spinae plane block on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic surgery

“…Thoracic paravertebral block (TPVB) has been employed to prevent postoperative pain after thoracic surgery (11). Erector spinae plane block (ESPB), a novel plane block first introduced by Forero et al (12) in 2016, provide analgesia for different surgeries such as lung surgery, laparoscopy, mastectomy, and pediatric surgery, and may also be effective for the management of chronic pain (12).…”