Comparative characteristics of regional anesthesia methods in thoracic surgery: a randomized prospective open-label controlled trial

OBJECTIVE: Comparative analysis of the effectiveness of regional anesthesia methods in thoracic surgery.

MATERIALS AND METHODS: 150 patients were examined, 75 of them underwent thoracotomy and 75 patients underwent surgery with VATS access. Depending on the type of regional anesthesia, patients were divided into one of five groups: group 1 - epidural blockade (n=30); group 2 - paravertebral blockade (n=30); 3rd group - ESP block (n=30), 4th group - SAP block (n=30); group 5 - control, only systemic anesthesia was used (n=30). The intensity of postoperative pain syndrome, the need for promedol and tramadol, the incidence of atelectasis, and hypotension were assessed. The length of stay of patients in the intensive care unit was recorded.

RESULTS: The lowest values of the median pain value during thoracotomy were recorded in patients with epidural blockade. In patients with ESP and SAP blocks, the pain syndrome was more pronounced and corresponded to the median values of the control group. EB and PVB with VATS access had the maximum analgesic effect, and the median values of the pain syndrome during ESP and SAP blocks made it possible to reduce the intensity of the pain syndrome relative to the control group. The general postoperative need for promedol was absent in patients of the epidural and paravertebral blockade groups. In the ESP, SAP-blocks and control groups, narcotic opioids were used in all patients with thoracotomy. With VATS access, in the ESP and SAP-blocks groups and in the control group, all patients in analgesic therapy used a narcotic analgesic. In patients in the control group, FBS was performed more often in absolute terms, however, there were no significant differences (p-value = 0.227, χ2 test). Arterial hypotonia in the epidural blockade group was significantly more common than in patients with other types of anesthesia (p-value=0.0164, chi-square test). The largest number of days the patient stayed in the ICU was recorded in the control group Me [Thoracotomy] - 3 days, Me [VATS] - 2 days. In the control group, only epidural block Me [Thoracotomy] - 2 days, Me [VATS] - 1 day, p=0.022, χ2 criterion and paravertebral block Me [Thoracotomy] - 2 days, Me [VATS] - 1 day, p=0.008, χ2 criterion, allowed to reduce the length of stay of patients in the ICU.

CONCLUSION: With thoracotomy, the choice remains with the epidural or paravertebral method of anesthesia. Epidural blockade more often than others causes the development of arterial hypotension. In the case of VATS access, ESP and SAP blocks can become an alternative to neuraxial methods. During the ESP block, catheterization can reduce the intensity of the pain syndrome compared to patients without it. The use of EB and PVB can reduce the length of stay of patients in the ICU.