Efficacy of ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing video-assisted thoracoscopic pulmonary lobectomy: a comparison with paravertebral nerve block

Abstract

Objective To evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy by comparing with paravertebral nerve block. Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20-27 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups (n=45 each) using a random number table: ultrasound-guided paravertebral nerve block (group P) and ultrasound-guided ESP block group (group E). Morphine 0.1 mg/kg and parecoxib sodium 40 mg were intravenously injected at 30 min before surgery.Ultrasound-guided ESP and paravertebral nerve blocks were performed with 0.5% ropivacaine 20 ml after anesthesia induction in E and P groups, respectively.Both groups received patient-controlled intravenous analgesia with 0.1% morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion.Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded.The operation time of nerve block and development of pleural puncture and vascular injury during operation were also recorded.The cumulative consumption of morphine was recorded at 2, 4, 6, 24 and 48 h after surgery.The development of postoperative nausea and vomiting and respiratory depression was recorded.Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3. Results The operation time of nerve block was significantly shorter in group E than in group P (P 0.05). Pleural puncture, vascular injury, pruritus or respiratory depression was not found in two groups. Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy. Key words: Nerve block; Pain, postoperative; Thoracoscopy