Background and objectives The 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).
Method In 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.
Results Eighty-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).
Conclusions The analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.
Trial registration number UMIN000030658.
- regional anesthesia
- truncal blocks
- acute pain
- postoperative pain
- pain outcome measurement
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Contributors YT: patient recruitment, study design, allocation, conducting the study, data analysis and writing the paper; YI: conducting the study and writing the paper; TF: patient recruitment, study design, conducting the study and writing the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Maruishi Pharmaceutical Cooperation (Osaka, Japan), which produces and distributes levobupivacaine in Japan, provided our hospital with non-financial support. Specifically, this company agreed to measure plasma levobupivacaine concentrations in patient samples without any compensation. We provided blood samples after patients provided written informed consent, and all samples were anonymized. The company was not engaged in this study in any other manner.
Patient consent for publication Obtained.
Ethics approval We conducted a single-center, double-blinded, prospective, randomized, non-inferiority trial approved by Institutional Review Board of Ehime Prefectural Central Hospital (Approval No. 29–84, Chairperson: Yasushi Ishida, 16/02/2018).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.