Comparative characteristics of regional anesthesia methods in thoracic surgery: randomized, prospective, open-label, controlled trial

Abstract

OBJECTIVE: To compare and analyze the effectiveness of regional anesthesia methods in thoracic surgery.
 MATERIALS AND METHODS: A total of 150 patients were examined, 75 each underwent thoracotomy and surgery with video-assisted thoracoscopic surgery (VATS) access. Depending on the type of regional anesthesia, patients were divided into one of these five groups: epidural blockade (EB) group (n=30), paravertebral blockade (PVB) group (n=30), erector spinae plane (ESP) block group (n=30), serratus anterior plane (SAP) block group (n=30), and control (group 5, only systemic anesthesia was used, n=30). The intensity of postoperative pain syndrome, need for promedol and tramadol, and incidence of atelectasis and hypotension were assessed. The length of stay in the intensive care unit (ICU) was recorded.
 RESULTS: The median pain value during thoracotomy was the lowest in the EB group. In the ESP and SAP block groups, the pain syndrome was more pronounced and corresponded to the median values of the control group. EB and PVB with VATS access had the maximum analgesic effect, and the median values of the pain syndrome during ESP and SAP blocks made it possible to reduce the intensity of the pain syndrome relative to the control group. The EB and PVB groups generally did not require promedol postoperatively. All patients with thoracotomy in the ESP block, SAP block, and control groups used narcotic opioids. With VATS access, in the ESP and SAP block groups and control group, all patients receiving analgesic therapy used a narcotic analgesic. In the control group, FBS was performed more often in absolute terms; however, no significant differences were found (p=0.227, 2 test). Arterial hypotonia in the EB group was significantly more common than that in patients with other anesthesia types (p=0.0164, chi-square test). The control group recorded the highest number of days of patient stay in the ICU (Me [thoracotomy], 3 days; Me [VATS], 2 days). In the control group, only the EB (Me [thoracotomy], 2 days; Me [VATS], 1 day, p=0.022, 2 criterion) and PVB (Me [thoracotomy], 2 days; Me [VATS], 1 day, p=0.008, 2 criterion) reduced the length of ICU stay.
 CONCLUSION: With thoracotomy, the choice remains between epidural or paravertebral anesthesia. EB more often than others causes arterial hypotension. In VATS access, ESP and SAP blocks can be alternatives to neuraxial methods. During the ESP block, catheterization can reduce pain intensity compared with those without it. EB and PVB can reduce the length of ICU stay.