Comparative Effectiveness of the Erector Spinae Block and Paravertebral Block in Thoracoscopic-Assisted Surgical Interventions: A single-center, prospective, randomized study

BACKGROUND: Effective management of postoperative pain in thoracic surgery is a critical task, as insufficient postoperative analgesia can lead to serious complications, including atelectasis, pneumonia, and chronic pain. Despite advances in pain management techniques, uncertainty remains for the optimal analgesia technique. Paravertebral block (PVB) is considered an effective analgesic technique for video-assisted thoracoscopic surgery (VATS); however, it requires a high level of expertise and carries certain risks. In recent years, the erector spinae plane block (ESPB) has gained popularity as an alternative regional anesthesia technique, but data on its efficacy remain controversial. Further research is needed to compare the advantages and disadvantages of these methods.

AIM: To compare the analgesic efficacy of ESPB and PVB in the perioperative period following VATS wedge lung resection in patients with oncological diseases.

MATERIALS AND METHODS: A single-center prospective randomized controlled study was conducted on 45 patients aged 18–75 years who underwent VATS biopsy or wedge lung resection. Patients were randomized into two groups: ESPB (n=22) and PVB (n=23). The primary endpoints included pain intensity in the intraoperative and postoperative periods, assessed using the numerical rating scale (NRS). Pain was evaluated at rest and during coughing, along with hemodynamic changes.

RESULTS: Pain intensity according to the NRS was minimal in both groups during the first 3 hours after extubation. However, a statistically significant difference was observed from the 4th hour, with lower pain scores in the PVB group (p<0.05). Pain during coughing was also lower in the PVB group for up to 48 hours postoperatively. No significant differences in fentanyl consumption were found between the groups (p=0.72). Anesthesia execution time was shorter in the ESPB group (p<0.05). Hypotension requiring vasopressor support was more frequent in the PVB group. Despite statistically significant differences, pain scores did not exceed 4 points within 48 hours in both groups, suggesting comparable effectiveness of the two blocks for this type of surgery.

CONCLUSION: The findings indicate that ESPB and PVB provide comparable postoperative analgesia following VATS lung resection. ESPB demonstrated technical simplicity and shorter execution time, whereas PVB provided a more pronounced analgesic effect during coughing. Given the shorter execution time, ESPB may be preferable in cases where PVB is associated with a high risk of complications.