Comparison of regional blocks performed under ultrasound navigation during thoracoscopic surgical interventions in children with malignant neoplasms: prospective randomized single center study

BACKGROUND: Thoracic epidural anesthesia is the gold standard for postoperative analgesia after thoracic surgery; its alternatives include paravertebral block (PVB) and erector spinae plane block (ESPB). However, ESPB has not been evaluated in comparison with intraoperative PVB for effectiveness and speed of recovery in the early postoperative period after thoracoscopic surgery in children with cancer.

AIM: Our aim was to investigate the analgesic effectiveness of erector spinae muscle block compared to thoracic paravertebral block for intra and postoperative analgesia during thoracoscopic surgical interventions in children with thoracic tumors.

MATERIALS AND METODS: A prospective, randomized, single-center study was conducted. The sample size was 90 patients (ESPB group, 45; PVB group, 45). Randomization was performed using computer-generated codes applying the hidden envelope method. Patient representatives and the investigators collecting outcome data were informed about the study. Participants were children aged <18 years with malignancy, ASA class I–II, and undergoing thoracoscopic surgery. The patients underwent ultrasound-guided blockades with the administration of local anesthetic at 2 mg/kg (ropivacaine) after general anesthesia induction and before surgical incision. Moreover, both groups received the same standardized pain management protocol during and after surgery. The main outcome was the effectiveness of analgesia, determined by the need for additional intraoperative opioid administration. The secondary outcomes included pain scores at rest and with movement within 24 hours postsurgery, 24-hour analgesic consumption, time to first analgesia, and postoperative complication incidence and severity.

RESULTS: The time (min) required to perform the block was significantly shorter (p <0.05) in the ESPB 5.5 (6; 8.5) group than in the PVB 11 (9; 12) group. No significant difference was found in the intraoperative fentanyl dose between the ESPB and PVB groups, which was 150 (100; 300) µg and 150 (100; 200) µg (p <0.65), respectively. The PVB group had lower VAS scores at 24 hours postoperatively (p <0.001). In the ESPB group, the mean (standard deviation) of total tramadol consumption was 120 (25) mg/day, and in the PVB group, 54 (12) mg/day (p <0.001). Pain scores according to the VAS and Wong–Becker scales during movement were lower in the PVB group at 1, 2, 6,12, and 24 hours postsurgery (p=0.025, 0.015, 0.03, 0.02, and 0.006).

CONCLUSION: In children with thoracic tumors who underwent thoracoscopic surgical interventions, ultrasound-guided PVB was more effective compared to ultrasound-guided ESPB performed in the postoperative period and induced a more pronounced and prolonged postoperative analgesic effect, although it was not inferior in providing intraoperative analgesia regarding opioid consumption. However, ESPB was easier to implement and required less time.