Abstract
IntroductionErector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Regional block is advocated in order to decrease opioid consumption and improve analgesia in urological surgery. Therefore, we aimed to explore whether ESPB would have similar analgesia compared with thoracic paravertebral block (TPVB) in laparoscopic nephroureterectomy.Methods and analysisThis prospective, randomized, double-blinded, non-inferiority trial will enroll 166 patients undergoing laparoscopic nephroureterectomy. Participants will be randomly assigned 1:1 into receiving ESPB or TPVB before surgery. Both ultrasound-guided ESPB and TPVB will be performed with an injection of 0.375% ropivacaine 0.4 ml/kg before anesthesia induction. Standardized patients controlled intravenous analgesia (PCIA) will be applied for each patient. The primary endpoint is the joint of cumulative 24 h opioid (sufentanil) consumption and average pain score via numeric rating scale (NRS) at 24 h after surgery. Secondary endpoints include rescued analgesic demand, cumulative opioid consumption, and pain NRS scores at different preset timepoints within 48 h after surgery. Other predefined outcomes include clinical features of blockage, quality of recovery, subjective sleep quality, time to ambulation and diet, and adverse events, as well as length of stay in hospital and anesthesia cost.DiscussionPrevious studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and TPVB in urological surgery are still lacking. Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain NRS score.Trial registrationChinese Clinical Trial Registry ChiCTR 2000031916. Registered on 14 April 2020.
Highlights
Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery
Previous studies investigating the analgesic efficacy of ESPB only concentrated on a single endpoint for postoperative pain evaluation, while studies focusing on the direct comparison between ESPB and thoracic paravertebral block (TPVB) in urological surgery are still lacking
Our study is the first trial in non-inferiority design of comparing ESPB and TPVB in patient undergoing laparoscopic nephroureterectomy, and the primary outcome is the joint endpoint of opioid consumption and pain numeric rating scale (NRS) score
Summary
Erector spinae plane block (ESPB) is a novel inter-fascial plane block, which is applied more and more in postoperative pain control, especially in chest surgery. Laparoscopic nephroureterectomy is increasingly gaining popularity for UTUC therapy due to its advantages of less invasive, faster recovery, and fewer complications. Speaking, this technique is started with detaching the ureter and kidney, and ligating the renal artery and vein through laparoscopic approach, subsequently resecting the distal ureter, partial bladder, and retrieving all specimens through a 5–8-cm arc or McBurney’s incision in the ipsilateral lower abdomen. A previous study has shown that patients often suffered moderate to severe pain after laparoscopic nephroureterectomy [2]. Multimodal analgesia including trunk block covering the incisions in lateral and anterior abdomen is advocated to enhance early recovery after laparoscopic nephroureterectomy
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