Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study
DOI:
https://doi.org/10.59958/hsf.7087Keywords:
thoracic paravertebral block, television assisted thoracic surgery, ultrasound guidance, erector spinae plane blockAbstract
Objective: This study aimed to compare the value of thoracic paravertebral block and ultrasound-guided erector spinal muscle plane block in video-assisted analgesia after thoracic surgery. Methods: Patients undergoing video-assisted thoracic surgery at our hospital from March 2022 to May 2023 were included as the subjects of this retrospective study. According to different analgesia methods, they were divided into an ultrasound group (acoustic-guided erector spinae plane block) and a conventional group (thoracic paravertebral block). General demographic data, sufentanil dose, propofol dose, blood loss and fluid replacement volume, puncture depth and time, length of stay, complications, number of analgesic pump compression, forced vital capacity (FVC), 1 s forced expiratory volume (FEV1), peak expiratory flow rate (PEFR), visual simulation (VAS) score, and 15 recovery quality evaluation components were collected Table (QoR-15). Propensity score matching (PSM) was used to balance the baseline data of the two groups. Data were analyzed by t test, chi-square test, and analysis of variance. Results: A total of 116 patients were included in this study, including 52 in the ultrasound group and 64 in the conventional group. Before PSM, statistically significant differences in age, weight, lesion location, and surgical methodmethod existed among the groups (p < 0.05). PSM matching was performed in a 1:1 ratio, and a total of 82 patients were enrolled in the ultrasound and conventional groups. The baseline data of the two groups were not statistically significant. The complications, hospital stay, pressing times of analgesic pump, and puncture depth and time in the ultrasound group were lower than those in the conventional group (p < 0.05). Two groups of tube drawing when resting and cough VAS difference (p > 0.05), but after 12, 24, and 48 h, ultrasonic VAS scores were lower than those of the normal group (p < 0.05). When two groups of T1 lung function difference (p > 0.05), but the T2, T3 FVC, FEV1, and PEFR ultrasound group were higher than those of the conventional group (p < 0.05). No significant difference in preoperative QoR-15 score existed between the two groups (p > 0.05), but the postoperative QoR-15 score in the ultrasound group was higher than that in the conventional group (p < 0.05). Conclusions: Ultrasound-guided erector spinae plane block had stronger analgesic effect, which can reduce the pressing times of analgesic pump, quickly reduce pain, and improve lung function with fewer complications. Thus, it can significantly improve the quality of postoperative recovery and reduce the length of hospital stay, rendering its application worthy of promotion.
References
Dubey AK, Gupta U, Jain S. Epidemiology of lung cancer and approaches for its prediction: a systematic review and analysis. Chinese Journal of Cancer. 2016; 35: 71.
Cheng TYD, Cramb SM, Baade PD, Youlden DR, Nwogu C, Reid ME. The International Epidemiology of Lung Cancer: Latest Trends, Disparities, and Tumor Characteristics. Journal of Thoracic Oncology: Official Publication of the International Association for the Study of Lung Cancer. 2016; 11: 1653–1671.
Klar M, Farthmann J, Bossart M, Stremmel C, Gitsch G, Passlick B, et al. Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer. Gynecologic Oncology. 2012; 126: 397–402.
Pan LY, Peng LP, Xu C, Ding C, Chen J, Wang WY, et al. Predictive factors of cough after uniportal video-assisted thoracoscopic pulmonary resection. Journal of Thoracic Disease. 2020; 12: 5958–5969.
Gad M, Abdelwahab K, Abdallah A, Abdelkhalek M, Abdelaziz M. Ultrasound-Guided Erector Spinae Plane Block Compared to Modified Pectoral Plane Block for Modified Radical Mastectomy Operations. Anesthesia, Essays and Researches. 2019; 13: 334–339.
Yi-Han W, Rong T, Jun L, Min W, Yan Z, Yi L, et al. Dexmedetomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial. BMC Musculoskeletal Disorders. 2022; 23: 235.
Kaciroti N, DosSantos MF, Moura B, Bellile EL, Nascimento TD, Maslowski E, et al. Sensory-Discriminative Three-Dimensional Body Pain Mobile App Measures Versus Traditional Pain Measurement With a Visual Analog Scale: Validation Study. JMIR MHealth and UHealth. 2020; 8: e17754.
Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. British Journal of Anaesthesia. 2022; 128: 1029–1039.
Hassan ME, Wadod MAA. Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study. Indian Journal of Anaesthesia. 2022; 66: 119–125.
Kukreja P, Herberg TJ, Johnson BM, Kofskey AM, Short RT, MacBeth L, et al. Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery. Cureus. 2021; 13: e18533.
Prasad MK, Varshney RK, Jain P, Choudhary AK, Khare A, Jheetay GS. Postoperative analgesic efficacy of fluoroscopy-guided erector spinae plane block after percutaneous nephrolithotomy (PCNL): A randomized controlled study. Saudi Journal of Anaesthesia. 2020; 14: 480–486.
Sen Y, Xiyang H, Yu H. Effect of thoracic paraspinal block-propofol intravenous general anesthesia on VEGF and TGF-β in patients receiving radical resection of lung cancer. Medicine. 2019; 98: e18088.
Zhen SQ, Jin M, Chen YX, Li JH, Wang H, Chen HX. Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients. World Journal of Clinical Cases. 2022; 10: 2174–2183.
Kim SH. Anatomical classification and clinical application of thoracic paraspinal blocks. Korean Journal of Anesthesiology. 2022; 75: 295–306.
Kusano Y, Kawagoe I, Yamaguchi A, Kishii J, Morita Y, Fukuda M, et al. Postoperative analgesia following robot-assisted thoracic surgery for mediastinal disease: retrospective comparative study of general anesthesia alone, combined with epidural analgesia, and with ultrasound-guided thoracic paraspinal block. Annals of Translational Medicine. 2023; 11: 206.
Zhang JW, Feng XY, Yang J, Wang ZH, Wang Z, Bai LP. Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block for perioperative analgesia in thoracoscopic pulmonary lobectomy: a randomized controlled trial. Insights into Imaging. 2022; 13: 16.
Lin H, Guan J, Luo S, Chen S, Jiang J. Bilateral Erector Spinae Plane Block for Quality of Recovery Following Posterior Lumbar Interbody Fusion: A Randomized Controlled Trial. Pain and Therapy. 2022; 11: 861–871.
Orhon Ergun M, Guclu Ozturk E, Zengin SU. Effects of Erector Spinae Plane Block on Postoperative Pain and Quality of Recovery Questionnaire Scores in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study. Cureus. 2023; 15: e36089.
Pirsaharkhiz N, Comolli K, Fujiwara W, Stasiewicz S, Boyer JM, Begin EV, et al. Utility of erector spinae plane block in thoracic surgery. Journal of Cardiothoracic Surgery. 2020; 15: 91.
Chaudhary O, Baribeau Y, Urits I, Sharkey A, Rashid R, Hess P, et al. Use of Erector Spinae Plane Block in Thoracic Surgery Leads to Rapid Recovery From Anesthesia. The Annals of Thoracic Surgery. 2020; 110: 1153–1159.
