The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery

Abstract

Background: This study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS).

Methods: In this prospective study, 120 patients aged 20-70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed.

Results: Intraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05).

Conclusion: Ultrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia.

Trial registration: The present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050 ); registration date: May 82,019.

Keywords: Erector spinae plane block; Opioid consumption; Postoperative rehabilitation; Thoracic epidural anesthesia; Video-assisted thoracic surgery.

Fig. 1

CONSORT flowchart. While 132 patients were initially screened as potentially suitable, 120 patients were finally randomized and included in the study. Group C, general anesthesia with patient-controlled intravenous analgesia (PCIA); group T, general anesthesia with patient-controlled epidural analgesia (PCEA); and group E, general anesthesia with continuous ESPB and PCIA. CONSORT, Consolidated Standards of Reporting Trials; ESPB, erector spinae plane block

Fig. 2

Perioperative sufentanil consumption. Group C, general anesthesia with patient-controlled intravenous analgesia (PCIA); group T, general anesthesia with patient-controlled epidural analgesia (PCEA); and group E, general anesthesia with continuous ESPB and PCIA. CONSORT, Consolidated Standards of Reporting Trials. ^*P < 0.05 versus group C

Fig. 3

Box plot of scores for the VAS by study groups across different study times: T1 = immediately out of post-anesthesia care unit (PACU); T2 = postoperative 6 h; T3 = postoperative 12 h; T4 = postoperative 24 h. Group C, general anesthesia with patient-controlled intravenous analgesia (PCIA); group T, general anesthesia with patient-controlled epidural analgesia (PCE); and group E, general anesthesia with continuous ESPB and PCIA. ^*P < 0.05 versus group C. ^#P < 0.05 versus group T. Median values shown as solid line. The whiskers represent the 5th and 95th percentile values. (A) VAS scores at rest; (B) VAS scores during coughing. VAS, visual analog scale

Fig. 4

Box plot of preoperative and postoperative scores for the QoR-15. Group C, general anesthesia with patient-controlled intravenous analgesia (PCIA); group T, general anesthesia with patient-controlled epidural analgesia (PCEA); and group E, general anesthesia with continuous ESPB and PCIA. ^*P < 0.05 versus group C. ^#P < 0.05 versus group T. QoR-15, Quality of Recovery-15