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Abstract
Background and objectives The evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery.
Methods We conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization.
Results Analysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI −9 to –12, p=0.79) on day 0, –1 (95% CI −11 to –8, p=0.81) on day 1 and −2 (95% CI −14 to –11, p=0.79) on day 2.
Conclusions The continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery.
Trial registration number Dutch Trial Register (NL6433).
- Postoperative Pain
- analgesia
- Pain Management
- Treatment Outcome
- REGIONAL ANESTHESIA
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @broekRenee, @barbaraversyck
Contributors RJCvdB has made substantial contributions to the conception and design of the work, the acquisition, analysis, and interpretation of data for the work, and drafted the work. JMCP has made substantial contributions to the design of the work; the acquisition, analysis, and interpretation of data for the work, and drafted the work. JSHAK has made substantial contributions to the design of the work; the interpretation of data for the work, and revised it critically for important intellectual content. CCvR, JRO and TJvB have made substantial contributions to the acquisition and interpretation of data, and revised it critically for important intellectual content. JSHAK has made substantial contributions to the design of the work, the interpretation of data for the work, and revised it critically for important intellectual content. AB and BV made substantial contributions to the conception and design of the work, the interpretation of data for the work, and revised it critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RJCvdB is the guarantor.
Funding This work was supported by the Stichting Onderzoeksfonds Catharina Ziekenhuis (Foundation Research Fund Catharina Hospital), Eindhoven, the Netherlands (Project 2018-7). This funding source had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results.
Competing interests AB is a clinical consultant for Philips Research (Eindhoven, the Netherlands) since January 2016. JSHAK received a grant from Werfen BV for unrelated research. The other authors declare no potential conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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