Erector Spinae Plane versus Paravertebral versus Multiple Intercostal Nerve Blocks in Patients undergoing VATS; A Randomized Controlled Trial

Abstract

Abstract Background Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique with shorter recovery times and lesser postoperative pain than open thoracotomies. Regional blocks decrease the anesthetic and postoperative analgesic requirements. Methods 105 patients scheduled for VATS under general anesthesiea were included. Patients were randomly allocated to receive ultrasound-guided erector spinae plane block (ESPB) on T4 and T6 levels (Group ESPB, n = 35), Paravertebral block (PVB) (Group PVB, n = 35) 20 ml bupivacaine 0.5% was injected after the anesthesia induction and turning the patient in the lateral position or multiple intercostal nerve blocks (Group MICNB, n = 35) 2–3 mL for each intercostal space from the third to the eighth intercostal nerve were injected by the surgeon through the thoracoscope. The objectives of this study were primarily to assess the effectiveness of the erector spinae plane versus paravertebral versus multiple intercostal nerve blocks on the intraoperative patient anesthetic requirements and secondarily to assess the postoperative analgesic requirements. Results No significant differences were observed regarding Et Sevo all over the operative time between the ESPB and the PVB group; however there were highly significant differences between either group and the MICNB group immediately after induction of anesthesia till 60 minutes later, No significant difference between ESPB and the PVB groups as regards to the total amount of intraoperative fentanyl used on the other hand there were highly significant difference between the ESPB or the PVB group and the MICNB group; while all the three groups provide comparable postoperative analgesia with non-significant difference regarding the postoperative VAS either during rest or cough. Conclusion ESPB and PVB provided better intraoperative anesthetic sparing effect than MICNB; however all the three blocks provide comparable postoperative analgesia either during rest or during cough in patients undergoing VATS. Trial registration: This trial was registered on ClinicalTrials.gov PRS (Protocol of Registration and Result System) on 25/ 10/ 2021. The clinical trial number is NCT05091398.