Comparative effectiveness of erector spinae plane block and paravertebral block in video-assisted thoracoscopic surgery: a single-center, prospective, randomized study

BACKGROUND: Effective postoperative analgesia in thoracic surgery is essential for preventing complications such as atelectasis, pneumonia, and chronic pain. Despite the proven efficacy of paravertebral block (PVB), its use requires significant experience and carries certain risks. Erector spinae plane (ESP) block is considered a promising alternative; however, its effectiveness remains controversial, necessitating further comparative evaluation of these techniques.

AIM: The work is aimed to compare the analgesic efficacy of ESP block and PVB during and after video-assisted thoracoscopic atypical lung resection.

METHODS: A single-center, prospective, randomized, controlled trial was conducted in 45 patients aged 18–75 years (median age 63 [59; 69]) who underwent video-assisted thoracoscopic biopsy or atypical lung resection. Patients were randomized into two groups: ESP block group (n = 22) and PVB group (n = 23). The primary endpoints were pain intensity during intraoperative and postoperative periods (at rest and during coughing), and analysis of hemodynamic changes.

RESULTS: Anesthesia performance time was significantly shorter in the ESP group (p < 0.05). Pain intensity on the numeric rating scale was minimal in both groups during the first 3 hours after extubation. However, starting from hour 4 a statistically significant difference was observed, with a slight reduction in pain in the PVB group (p < 0.05). In the PVB group, pain scores during coughing remained lower throughout the 48-hour postoperative period. There was no significant difference between groups in fentanyl requirement (p = 0.72). Arterial hypotension requiring vasopressor support occurred more frequently in the PVB group. Despite the statistically significant differences, pain intensity did not exceed the score of 4 points on the numeric rating scale in either group over the 48-hour period.

CONCLUSION: During thoracoscopic interventions on the lungs in patients with cancer, the use of ESP block ensured a postoperative analgesic effect comparable to that of paravertebral block, accompanied by lower influence on hemodynamic indicators.