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Randomized Controlled Trial
. 2024 Apr 23;24(1):156.
doi: 10.1186/s12871-024-02544-3.

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

A Clairoux  1   2 , A Moore  3   4 , M Caron-Goudreault  5   2 , M Soucy-Proulx  5   2 , M Thibault  5   2 , V Brulotte  1   2 , M E Bélanger  1   2 , J Raft  6 , N Godin  1 , M Idrissi  1 , J Desroches  5 , M Ruel  5 , A Fortier  7 , P Richebé  1   2
Affiliations
Randomized Controlled Trial

Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial

A Clairoux et al. BMC Anesthesiol. .

Abstract

Introduction: There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery.

Methods: We conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects.

Results: There was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery.

Conclusion: Our multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.

Keywords: Erector spinae plane block; Plane blocks; Recovery score; Regional anesthesia; Thoracic surgery; Video-assisted thoracoscopic surgery.

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Conflict of interest statement

PR received honorarium as a consultant and gives lectures from the following companies: Medasense, Abbvie, Medtronic-Covidien, Biosyent, Merck.

Figures

Fig. 1
Fig. 1
Study flow chart (CONSORT 2010 Flow Diagram). CONSORT indicates CONsolidated Standards Of Reporting Trials ESP = Erector spinae plane
See this image and copyright information in PMC

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