Comparisons in analgesic effects between ultrasound-guided erector spinae plane block and surgical intercostal nerve block after video-assisted thoracoscopic surgery: A randomized controlled trial

• Published in: Journal of clinical anesthesia Vol. 95; p. 111448
• Main Authors: Sung, Chun-Sung, Wei, Tzu-Jung, Hung, Jung-Jyh, Su, Fu-Wei, Ho, Shih-I, Lin, Mong-Wei, Chan, Kuang-Cheng, Wu, Chun-Yu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2024; Elsevier Limited
• Subjects: Adult; Aged; Analgesics; Analgesics, Opioid - administration & dosage; Clinical trials; Double-Blind Method; Erector spinae plane block; Female; General anesthesia; Hospitals; Humans; Intercostal nerve block; Intercostal Nerves - drug effects; Length of Stay - statistics & numerical data; Male; Middle Aged; Morphine; Morphine - administration & dosage; Nerve Block - methods; Pain management; Pain Measurement; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Paraspinal Muscles - innervation; Patients; Recovery (Medical); Software; Statistical analysis; Surgeons; Thoracic surgery; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - methods; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional; Ventilation; Video-assisted thoracoscopic surgery; Intercostal nerve block; Video-assisted thoracoscopic surgery; Erector spinae plane block
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2024.111448

This study aimed to compare the analgesic effects of anesthesiologist-administrated erector spinae plane block (ESPB) and surgeon-administrated intercostal nerve block (ICNB) following video-assisted thoracoscopic surgery (VATS). Randomized, controlled, double-blinded study. Operating room, postoperative recovery room and ward in two centers. One hundred patients, ASA I-III and scheduled for elective VATS. The anesthesiologist-administrated ESPB under ultrasound guidance or surgeon-administrated ICNB under video-assisted thoracoscopy was randomly provided during VATS. Regular oral non-opioid analgesic combined with intravenous rescue morphine were prescribed for multimodal analgesia after surgery. The primary outcomes were the pain score and morphine consumption during 48 h after surgery. Postoperative pain intensity were assessed using the 10-cm visual analogue scale at 1 h, 24 h, and 48 h after surgery. Morphine consumption at these time points was compared between the two study groups. Furthermore, oral weak opioid rescue analgesic was also provided at 24 h after surgery. Postoperative quality of recovery at 24 h was also assessed using the QoR-15 questionnaire, along with duration of chest tube drainage and hospital stay were compared as secondary outcomes. Patients in the two study groups had comparable baseline characteristics, and surgical types were also similar. Postoperative VAS changes at 1 h, 24 h, and 48 h after surgery were also comparable between the two study groups. Both groups had low median scores (<4.0) at all time points (all p > 0.05). Patients in the ESPB group required statistically non-significant higher 48-h morphine consumption [3 (0–6) vs. 0 (0–6) mg in the ESPB group and ICNB group respectively; p = 0.135] and lower numbers of oral rescue analgesic (0.4 ± 1.2 vs. 1.0 ± 1.8 in the ESPB group and ICNB group respectively; p = 0.059). Additionally, patients in the two study groups had similar QoR15 scores and lengths of hospital stay. Both anesthesiologist-administered ultrasound-guided ESPB and surgeon-administered VATS ICNB were effective analgesic techniques for patients undergoing VATS for tumor resection. [Display omitted] •Patients having video-assisted thoracoscopic surgeries (VATS) report moderate to severe pain.•Accessible regional analgesia is important in VATS for pain management.•Surgeon administered ICNB is an alternative option compared to anesthesiologist administered ESPB.•Both ESPB and ICNB can result in good pain control with similar opioid consumption after VATS.