Objectives
The objective of this study was to compare analgesic efficacy of erector spinae plane
block (ESPB), thoracic paravertebral block (TPVB), and intercostal nerve block (ICNB)
after video-assisted thoracoscopic surgery (VATS).
Design
Prospective, randomized, single-blind study.
Setting
University hospital, single institution.
Participants
Adult patients undergoing VATS.
Interventions
Ultrasonography-guided ESPB, ultrasonography-guided TPVB, or ICNB.
Measurements and Main Results
Patients were enrolled into the following three groups according to analgesia technique
as ESPB, TPVB, or ICNB, respectively, group erector spinae plane block (GESP) (n = 35),
group thoracic paravertebral block (GTPV) (n = 35), and group intercostal nerve block
(GICN) (n = 36). Multimodal analgesia was achieved with paracetamol, tenoxicam, and
intravenous morphine (via patient-controlled analgesia) for all study groups. Pain
scores were assessed by visual analog scale, and morphine consumption, rescue analgesic
requirement, and side effects were recorded postoperatively. Dynamic visual analog
scale at the first hour as primary outcome was determined five (two-seven), four (one-six)
and (two-six) in GESP, GTPV, and GICN, respectively. Dynamic pain scores were significantly
lower in GTPV compared with GESP and GICN at 24 hours (p < 0.017). Dynamic pain scores
in GICN were significantly lower at 12 hours compared with GESP (p < 0.017). Morphine
consumption for the first 24 hours was similar in GICN and GTPV, and it was significantly
lower in GICN and GTPV in comparison to GESP (p < 0.017). Rescue analgesic requirement
and side effects were similar among groups.
Conclusions
All three blocks can obtain sufficient analgesia after VATS; however, TPVB appeared
to be the preferable method compared with ESPB and ICNB, with a more successful analgesia
and less morphine consumption.
Key Words
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Article info
Publication history
Published online: November 19, 2020
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
