Evaluation of Rhomboid Intercostal Block in Video-Assisted Thoracic Surgery: Comparing Three Concentrations of Ropivacaine

Abstract

Background: Ultrasound-guided rhombic intercostal block (RIB) is a novel regional block that provides analgesia for patients who have received video-assisted thoracoscopic surgery (VATS). The anesthetic characteristics of ultrasound-guided RIB with different concentrations of ropivacaine are not known. This research primarily hypothesizes that ultrasound-guided RIB, given in combination with the same volume of different concentrations of ropivacaine, would improve the whole quality of recovery-40 (QoR-40) among patients with VATS. Approaches: This double-blinded, single-center, prospective, and controlled trial randomized 100 patients undergoing VATS to receive RIB. One hundred patients who have received elective VATS and satisfied inclusion standards were fallen into four groups randomly: control group with no RIB and R_0.2%, R_0.3%, and R_0.4%; they underwent common anesthesia plus the RIB with ropivacaine at 0.2%, 0.3%, and 0.4% in a volume of 30 ml. Outcomes: Groups R_0.2%, R_0.3%, and R_0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the control group (Group C) (p < 0.001 for all contrasts). Groups R_0.3% and R_0.4% displayed great diversities in the overall QoR-40 scores and QoR-40 dimensions (in addition to psychological support) by comparing with the R_0.2% group (p < 0.001 for all contrasts). The overall QoR-40 scores and QoR-40 dimensions [physical comfort (p = 0.585)] did not vary greatly between Groups R_0.3% and R_0.4% (p > 0.05 for all contrasts). Groups R_0.2%, R_0.3%, and R_0.4% showed significant differences in numerical rating scales (NRS) score region under the curve (AUC) at rest and on movement in 48 h when compared with the Group C (p < 0.001 for all contrasts). Groups R_0.3% and R_0.4% displayed great diversities in NRS score AUC at rest and on movement in 48 h when compared with the R_0.2% group (p < 0.001 for all contrasts). The NRS mark AUC at rest and, on movement in 48 h, did not vary greatly between the Group R_0.3% and R_0.4% (p > 0.05 for all contrasts). Conclusion: In this study it was found that a dose of 0.3% ropivacaine is the best concentration for RIB for patients undergoing VATS. Through growing ropivacaine concentration, the analgesia of the RIB was not improved greatly. Clinicaltrials.gov Registration: https://clinicaltrials.gov/, identifier ChiCTR2100046254.

Keywords: analgesic; anesthesia; quality of recovery; rhomboid intercostal blocky; video-assisted thoracoscopic surgery.

FIGURE 1

Consolidated standards of reporting trials statement flow diagram for the study.

FIGURE 2

(A). Time to first postoperative analgesic request, (B). Postoperative 48-h total amount of opioids, (C). Parecoxib sodium for injections, (D). Satisfaction score of patients.^* p < 0.05 compared with R_0.2%, R_0.3%, and R_0.4% groups, ^# p < 0.05 compared with R_0.3% and R_0.4% groups.