ORIGINAL ARTICLE   

Minerva Anestesiologica 2023 March;89(3):138-48

DOI: 10.23736/S0375-9393.22.16639-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Comparison of efficacy of erector spinae plane block, thoracic paravertebral block, and erector spinae plane block and thoracic paravertebral block combination for acute pain after video-assisted thoracoscopic surgery: a randomized controlled study

Musa ZENGIN ¹ ✉, Ali ALAGÖZ ¹, Hilal SAZAK ¹, Gülay ÜLGER ¹, Ramazan BALDEMIR ¹, Mert ŞENTÜRK ²

¹ Department of Anesthesiology and Reanimation, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Ankara, Türkiye; ² Department of Anesthesiology and Reanimation, Faculty of Medicine, Istanbul University, Istanbul, Türkiye

BACKGROUND: The aim of this study was to compare the efficacy of ultrasound-guided erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and ESPB and TPVB combination on acute pain after video-assisted thoracoscopic surgery (VATS).
METHODS: Seventy-five patients were evaluated (three groups: ESPB, TPVB, or combined ESPB-TPVB [comb-group], each 25 patients). All interventions were performed with the same volume of bupivacaine (20 mL). Primary outcome was VAS (Visual Analog Scale) during the first 24 hours. Secondary outcomes were postoperative morphine consumption and rescue analgesic requirements.
RESULTS: VAS during rest and coughing of TPVB was significantly higher compared to other groups (in all measurements compared to comb-group; and in all but 24 hours measurement to ESPB) ESPB and comb-group had similar VAS in all measurements (e.g., median VAS in ESPB, TPVB and comb-group at 8^th hour: 3-4-2 [P=0.014] during coughing and 2-3-1 in rest [P<0.001], respectively). Morphine consumption was statistically significantly higher in TPVB than comb-group (ESPB: 15.28 mg; TPVB: 19.30 mg; ESPB+TPVB: 10.00 mg) (P=0.003). Rescue analgesic requirement was statistically significantly higher in the TPVB group than comb-group (P=0.009).
CONCLUSIONS: ESPB alone and the combination of ESPB and TPVB provided superior primary outcomes compared to TPVB alone. Morphine and rescue analgesic consumptions were higher in TPVB than comb-group. ESPB and comb-group were statistically similar in terms of primary and secondary outcomes. This study is one of the first studies using the combination of ESBP and TPVB for pain after VATS, and shows the efficacy of this approach.

KEY WORDS: Anesthesiology; Thoracic surgery, video-assisted; Visual Analog Scale