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Reply to Dr. Wang et al
  1. Yasuko Taketa,
  2. Yumi Irisawa and
  3. Taro Fujitani
  1. Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
  1. Correspondence to Dr Yasuko Taketa, Ehime Kenritsu Chuo Byoin, Matsuyama, Ehime, Japan; suko1231{at}yahoo.co.jp

https://doi.org/10.1136/rapm-2020-101283

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    To the Editor

    We are grateful to Dr Wang et al1 for their insightful comments on our recent publication.2 However, we are partially uncertain regarding the meaning of their comments. As they have pointed out, we also consider that the anesthetic characteristics of the erector spinae plane block (ESPB) remain unclear. However, based on a number of recent case reports that have demonstrated the efficacy of ESPB, we conducted this study for evaluating its efficacy. We wish to clarify two aspects in this context. First, the primary outcome of this study was whether the static numerical pain rating score of the ESPB group evaluated 24 hours postoperatively was noninferior to that of the thoracic paravertebral block (TPVB) group; it was found that the ESPB group was not at least clinically inferior to the TPVB group at this time point. Second, we believe that ESPB should not be used alone, but as a component of multimodal analgesia, especially in perioperative analgesia. The result was based on this perspective, and we have also mentioned this in the limitation section. Numerous additional analgesics were compared throughout the postoperative 48 hours as one of the secondary outcomes. In the non-inferiority trial, the study was conducted on the basis of “whether or not inferior within clinically significant differences.” We believe that the superiority of the secondary outcomes should not mislead the results.

    In the present study, we adopted the same levobupivacaine dose per hour for both groups. Moreover, the infusion rate was a clinically used setting. The plasma concentration of levobupivacaine was measured under strictly blinded conditions. We were unable to understand the reason behind Dr. Wang and colleagues’ claim that TPVB could result in lower plasma concentrations merely because the mechanism of action of ESPB was unknown.

    We again appreciate their comments on our findings. We anticipate that the effects and mechanism of interfascial plane blocks, including ESPB, will be further elucidated in the future.

    References

    1. ↵
      1. Wang K,
      2. An N,
      3. Jiang X, et al
      . Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med2019.doi:10.1136/rapm-2019-101225
    2. ↵
      1. Taketa Y,
      2. Irisawa Y,
      3. Fujitani T
      . Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial. Reg Anesth Pain Med2019. doi:doi:10.1136/rapm-2019-100827. [Epub ahead of print: 08 Nov 2019].

    Footnotes

    • Contributors YT: Writing the paper; YI: Writing the paper; TF: 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 None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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