Comparison of the effects of ultrasound-guided thoracic paravertebral block and erector spinae plane block on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic surgery

Year 2022, , 1600 - 1605, 25.10.2022

Musa Zengin , Gülay Ülger , Ramazan Baldemir , Hilal Sazak , Koray Aydoğdu , Ali Alagöz

https://doi.org/10.32322/jhsm.1176638

Cited By: 3

Abstract

Aim: The aim of the study was to compare the effects of ultrasound (US)-guided Erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) on postoperative acute and chronic pain.
Material and Method: Patients aged range of 18 to 80 years and underwent video-assisted thoracoscopic surgery (VATS) were included in a single-blinded randomized trial. All patients were informed about the study and their written consent was obtained. The primary outcome was determined as acute postoperative visual analog scale (VAS) scores, and secondary outcomes were postoperative morphine consumption and the incidence of chronic pain. US-guided ESPB and TPVB were performed to all patients and they were assigned randomly to ESPB (Group 1) and TPVB (Group 2) groups according to the analgesia protocol.
Results: Visual analog scale (VAS) resting and VAS cough scores at the 1st, 2nd, 4th, 8th, and 16th hours were found to be statistically significantly higher in the TPVB group than in the ESPB group (p<0.05) Morphine consumption (p:0.042) and additional analgesic (p:0.037) use were found to be statistically significantly higher in the TPVB group compared to the ESPB group. As complications, only nausea and vomiting were observed with no significant difference between the groups (p>0.05). There was no significant difference in terms of postoperative 30th and 90th day pain characteristics between the groups (p>0.05).
Conclusion: ESPB was superior to TPVB in terms of acute postoperative pain management, morphine consumption, and side effects, but the incidence of chronic pain in the first and third months after surgery was similar in both groups.

Keywords

Acute pain, chronic pain, erector spinae plane block, thoracic paravertebral block, video-assisted thoracoscopic surgery

References

• Bayman EO, Parekh KR, Keech J, et al. Preoperative patient expectations of postoperative pain are associated with moderate to severe acute pain after vats. Pain Med 2019; 20: 543-54.
• Kwon ST, Zhao L, Reddy RM, et al. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection. J Thorac Cardiovasc Surg 2017; 154: 652-9.
• Zengin M, Baldemir R, Ulger G, et al. Postoperative analgesic efficacy of thoracic paravertebral block and erector spinae plane block combination in video-assisted thoracic surgery. Cureus 2021; 13: e15614.
• Hanley C, Wall T, Bukowska I, et al. Ultrasound-guided continuous deep serratus anterior plane block versus continuous thoracic paravertebral block for perioperative analgesia in videoscopic-assisted thoracic surgery. Eur J Pain 2020; 24: 828-38.
• Steegers MA, Snik DM, Verhagen AF, et al. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain 2008; 9: 955-61.
• Barbera C, Milito P, Punturieri M, et al. Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study. J Pain Res 2017; 10: 73-7.
• Komatsu T, Kino A, Inoue M, et al. Paravertebral block for video-assisted thoracoscopic surgery: analgesic effectiveness and role in fast-track surgery. Int J Surg 2014; 12: 936-9.
• Zengin M, Alagoz A. Comparison of thoracic epidural analgesia and thoracic paravertebral block applications in the treatment of acute pain after thoracotomy in geriatric patients. Cureus 2021; 13: e18982.
• Yeap YL, Wolfe JW, Backfish-White KM, et al. Randomized prospective study evaluating single-injection paravertebral block, paravertebral catheter, and thoracic epidural catheter for postoperative regional analgesia after video-assisted thoracoscopic surgery. J Cardiothorac Vasc Anesth 2020; 3: 1870-6.
• Scarci M, Joshi A, Attia R. In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg 2010; 10: 92-6.
• Xu ZZ, Li X, Zhang Z, et al. Ultrasound-guided erector spinae plane block versus thoracic paravertebral block on postoperative analgesia after laparoscopic nephroureterectomy: study protocol of a randomized, double-blinded, non-inferiority design trial. Trials 2021; 22: 249.
• Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-7.
• Chin KJ, El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anaesth 2021; 68: 387-408.
• Turhan Ö, Sivrikoz N, Sungur Z, et al. Thoracic paravertebral block achieves better pain control than erector spinae plane block and intercostal nerve block in thoracoscopic surgery: a randomized study. J Cardiothorac Vasc Anesth 2021; 35: 2920-7.
• Zhao H, Xin L, Feng Y. The effect of preoperative erector spinae plane vs. paravertebral blocks on patient-controlled oxycodone consumption after video-assisted thoracic surgery: A prospective randomized, blinded, non-inferiority study. J Clin Anesth 2020; 62: 109737.
• Altiparmak B, Toker MK, Uysal Aİ, et al. Eficácia do bloqueio do plano do músculo eretor da espinha guiado por ultrassom para analgesia após colecistectomia laparoscópica: um estudo controlado randômico [Efficacy of ultrasound-guided erector spinae plane block for analgesia after laparoscopic cholecystectomy: a randomized controlled trial]. Braz J Anesthesiol 2019; 69: 561-8.
• Yang HM, Choi YJ, Kwon HJ, et al. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia 2018; 73: 1244-50.
• Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med 2018; 43: 567-71.
• El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia 2017; 72: 434-8.
• Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg 2009; 36: 170-80.
• Maguire MF, Ravenscroft A, Beggs D, et al. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg 2006; 29: 800-5.
• Urits I, Charipova K, Gress K, et al. Expanding role of the erector spinae plane block for postoperative and chronic pain management. Curr Pain Headache Rep 2019; 23: 71.
• Pabón-Muñoz FE, Luna-Montúfar CA, Paredes MR. The ultrasound-guided erector spinae plane (ESP) block in chronic pain due to bone metastasis: case report. Colombian Journal of Anesthesiology 2019; 47: 128-131.