Thoracic Paravertebral Block Achieves Better Pain Control Than Erector Spinae Plane Block and Intercostal Nerve Block in Thoracoscopic Surgery: A Randomized Study

Abstract

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). Prospective, randomized, single-blind study. University hospital, single institution. Adult patients undergoing VATS. Ultrasonography-guided ESPB, ultrasonography-guided TPVB, or ICNB. 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. 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.