Analgesic efficacy of continuous erector spinae plane block vs. opioid-based regimen for postoperative pain management following video-assisted thoracoscopic lung resection: a prospective, randomised, open-label, non-inferiority trial.

INTRODUCTION

Video-assisted thoracoscopic lung resection causes significant postoperative pain. We hypothesised that continuous erector spinae plane block would provide non-inferior analgesia compared with a conventional opioid-based regimen for this procedure.

METHODS

Patients were allocated randomly to continuous erector spinae plane block (continuous infusion of 0.25% ropivacaine via perineural catheters (5 ml.h-1) combined with programmed intermittent bolus (10 ml every 6 h for the initial 24 h)) or conventional opioid-based regimen (continuous infusion of opioid (2 μg.kg-1 sufentanil and 16 mg ondansetron diluted to 100 ml with 0.9% normal saline) at 2 ml.h-1 for 48 h). The primary outcome was overall analgesic efficacy with cough, quantified by the cumulative area under curve for the pain numeric rating scale scores, from post-anaesthesia care unit discharge to 48 h postoperatively.

RESULTS

The cumulative area under curve for the pain numeric rating scale score in patients allocated to the continuous erector spinae plane block group was non-inferior to those allocated to the conventional group (mean difference - 0.99, 95%CI -11.97-9.98, p = 0.011). Patients allocated to the continuous erector spinae plane block group showed superior quality of recovery-15 scores at 24 h (median difference 11, 95%CI 6-16, p < 0.001) and 48 h postoperatively (median difference 10, 95%CI 7-15, p < 0.001), alongside reduced postoperative pulmonary complications (relative risk 0.45, 95%CI 0.21-0.96, p = 0.031). Safety outcomes favoured continuous erector spinae plane block, with lower incidences of postoperative nausea (relative risk 0.17, 95%CI 0.04-0.73, p = 0.005); retching (relative risk 0.11, 95%CI 0.02-0.89, p = 0.023); and dizziness (relative risk 0.22, 95%CI 0.07-0.72, p = 0.005).

DISCUSSION: Following video-assisted thoracoscopic lung resection, continuous erector spinae plane block provides non-inferior postoperative analgesia compared with conventional opioid-based regimen whilst enhancing recovery quality significantly and reducing complications.