A Comparison Of Paravertebral Block,Erector Spinae Plane Block And The Combination Of Erector Spinae Plane Block And Paravertebral Block For Postoperative Analgesia After Video-assisted Thoracoscopic Surgery

Objectives: This study was to determine the analgesic effect of ultrasound-guided erector spinae plane block(ESPB)and paravertebral block(PVB)as well as the combination of PVB and ESPB(P+E)after video-assisted thoracoscopic surgery(VATS).Methods: A total of 69 patients aged from 18-80 undergoing VATS were randomized to receive ESPB,PVB or PVB combined with ESPB with 0.5% ropivacaine(20ml).The primary outcome was cumulative hydromorphone consumption at 12 h,24h and 48 h.The secondary outcomes were Visual Analogue Scale(VAS)scores at rest and while coughing at 0h,12 h,24h,48 h and 72 h postoperatively,rescue analgesia requirement,side effects,intraoperative hemodynamic changes and vasoactive drug dosage.Results: The median [IQR] hydromorphone consumption,including converted oxycodone,was significantly different at 48 h postoperatively among the three groups(ESPB,10.24[9.53-11.71] mg;PVB,9.94 [9.19-10.75] mg;P+E,9.44 [8.96-9.97] mg;P=0.011).Hydromorphone consumption in P+E group was lower compared with that in ESPB group at 12 h,24h and 48h(P<0.001,P=0.004,and P=0.003 respectively).VAS scores at rest were significantly higher for ESPB group compared to P+E group at 0h postoperatively(P=0.009).VAS scores while coughing were significantly higher for ESPB group compared to P+E group at 0h and 12 h postoperatively(P=0.015 and P<0.001)and to the PVB group at 12 h postoperatively(P=0.002).More patients needed rescue analgesia in ESPB group compared to those in P+E group in 0-12 h,0-24 h and 0-48h(P=0.022,0.035,and 0.035 respectively).Conclusions: Ultrasound-guided PVB combined with ESPB provided superior analgesia to ESPB for VATS.The combination of ESPB and PVB might be an effective alternative to PVB in alleviating postoperative pain in VATS.