PT  - JOURNAL ARTICLE
AU  - Klaibert, Beau
AU  - Lohser, Jens
AU  - Tang, Raymond
AU  - Jew, Michael
AU  - McGuire, Anna
AU  - Wilson, Jason
TI  - Efficacy of ultrasound-guided single-injection erector spinae plane block for thoracoscopic wedge resection: a prospective randomized control trial
AID  - 10.1136/rapm-2022-103602
DP  - 2022 Sep 23
TA  - Regional Anesthesia & Pain Medicine
PG  - rapm-2022-103602
4099  - http://rapm.bmj.com/content/early/2022/09/23/rapm-2022-103602.short
4100  - http://rapm.bmj.com/content/early/2022/09/23/rapm-2022-103602.full
AB  - 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.Data are available upon reasonable request.