Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block for perioperative analgesia in thoracoscopic pulmonary lobectomy: a randomized controlled trial

Jian-Wen Zhang,Jing Yang,Li-Ping Bai,Xiao-Yue Feng,Zhi-Hao Wang,Zhe Wang

doi:10.1186/s13244-021-01151-x

Abstract

ObjectiveTo explore the effect of a single preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) and erector spinae plane block (ESPB) for perioperative analgesia in thoracoscopic pulmonary lobectomy.MethodsSeventy-two patients aged 40–70 years who underwent thoracoscopic pulmonary lobectomy under general anesthesia were enrolled and randomly divided into the control group (Group C), the TPVB group (Group T) and the ESPB group (Group E). The primary observation indicators included the visual analogue scale (VAS) at 1, 6, 12, 24, and 48 h postoperatively at rest and with a cough. The secondary observation indicators included the intraoperative sufentanil consumption, anesthesia awakening time and extubation time, the sufentanil consumption in the analgesic pump, and flurbiprofen ester consumption for remedial analgesia within 48 h after surgery and the incidence of postoperative adverse events.ResultsThe intraoperative sufentanil consumption, anesthesia awakening time, and extubation time were lower in groups T and E than those in group C (p < 0.05). Patients in group T had lower VAS scores at rest and with a cough at 1, 6, and 12 h postoperatively than in group C at the same time points (p < 0.05). The VAS scores at rest at 1 and 6 h postoperatively and coughing status at 1, 6, and 12 h postoperatively were lower in group E than in group C at the same time points (p < 0.05).ConclusionThe ultrasound-guided preoperative single TPVB and ESPB for thoracoscopic pulmonary lobectomy could both reduce the postoperative pain VAS score and reduce the dose of perioperative sufentanil and postoperative remedial analgesics.

Highlights

Thoracic paravertebral nerve block (TPVB) is a nerve block technique in which the local anesthetic is injected into the thoracic paravertebral space to block the thoracic spinal nerve, its branches, and the sympathetic trunk, providing analgesia comparable to that of a thoracic epidural block
Preoperative ultrasound-guided single TPVB and Erector spinae plane block (ESPB) for thoracoscopic pulmonary lobectomy could reduce the visual analogue scale (VAS) of postoperative pain in patients and decrease the perioperative sufentanil and postoperative remedial analgesic medications
General characteristics Eighty patients undergoing elective thoracoscopic pulmonary lobectomy under general anesthesia with tracheal intubation were selected for the present study

Summary

Introduction

Thoracic paravertebral nerve block (TPVB) is a nerve block technique in which the local anesthetic is injected into the thoracic paravertebral space to block the thoracic spinal nerve, its branches, and the sympathetic trunk, providing analgesia comparable to that of a thoracic epidural block. Kang et al [2] found that in patients with lung cancer undergoing thoracoscopic radical surgery, the preoperative TPVB at T4–5 and T6–7 resulted in significantly lowered pain scores and oxycodone doses within 24 h after surgery, and patients had significantly better sleep quality and higher completion rates of walking tests postoperatively. Erector spinae plane block (ESPB) is a new regional anesthesia technique recently described by Forero et al [3] to treat chronic thoracic neuropathic pain. ESPB is performed by depositing local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process. When ESPB is performed bilaterally, it has been reported to be as effective as thoracic epidural analgesia [7]

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