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Abstract
Background Despite advances in minimally invasive thoracic surgery, patients remain at risk of adverse pulmonary events with suboptimal postoperative analgesia. Novel methods of regional analgesia are warranted. Our objective was to prospectively evaluate the impact of ultrasound-guided single-injection erector spinae plane (ESP) block with ropivacaine compared with placebo control on standard of care postoperative recovery in subjects undergoing video-assisted thoracoscopic surgery (VATS) wedge resection.
Methods This prospective, randomized, placebo-controlled, double-blinded study was conducted at a tertiary thoracic surgical center. Consecutive subjects undergoing VATS wedge resection were randomized to receive a single-injection ESP block with 0.5% ropivacaine or 0.9% saline placebo, in addition to the current standard of care of multimodal analgesia including patient-controlled analgesia and surgical local anesthetic wound infiltration. The primary outcome was difference in 40-point Quality of Recovery (QoR-40) on day 1 postoperatively. The secondary outcomes included opioid consumption, Visual Analog Pain Scale (VAS) score, time spent in the postanesthesia care unit (PACU), and block-related and postoperative complications.
Results Eighty subjects were enrolled, 40 in each group, with 76 completing follow-up (38 subjects in each group). There was no difference in the median QoR-40 score between groups, 169.5 for the ropivacaine group and 172.5 for the control group (difference 3, p=0.843). No significant differences existed between groups in all secondary outcomes, with the exception of the ropivacaine group having lower VAS pain scores measured at 1 hour postoperatively and a shorter duration of stay in the PACU of 117 min.
Conclusions Following VATS wedge resection, the addition of an ESP block with ropivacaine to standard multimodal analgesia is unlikely to add meaningful clinical value.
Trial registration number NCT03419117.
- REGIONAL ANESTHESIA
- Pain, Postoperative
- analgesia
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @DrRayTang
Contributors BK and JW designed and conducted the study, including protocol design and write-up, ethics and institutional approval applications, subject recruitment, data collection and analysis, and manuscript write-up. MJ contributed through subject recruitment and follow-up, data input, and manuscript write-up. RT, AM, and JL were consulted for protocol design and assisted with analysis and with original and revised manuscript writing. AM provided participants for the study from her thoracic surgical practice. Both BK and JW at as guarantors of this study; both share responsibility for the finished work and the conduct of the study, had full access to the data, and controlled the decision to publish.
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 AM receives research funding from Canexia Health, Vancouver, British Columbia, and AstraZeneca Canada, activities unrelated to the current research study.
Provenance and peer review Not commissioned; externally peer reviewed.