A Comparison Of Ultrasound-guided Paravertebral,intercostal And Erector Spinae Plane Block On Postoperative Analgesic Effect After Thoracoscopic Surgery

ObjectiveThis trial was to compare the analgesic effect of ultrasound-guided paravertebral nerve block,intercostal nerve block and erector spinae plane block after thoracoscopic surgery.MethodSeventy-five patients in our hospital from 2018 to 2019,aged 18–75 years,American Society of Anesthesiologists(ASA)physical status I–II and undergoing selective unilateral thoracoscopic partial pulmonary resection,were randomly divided into the three groups.Group one was paravertebral nerve block(PVB)group,Group two was intercostal nerve block(ICNB)group and Group three was erector spinae plane block(ESPB)group.Each group included 25 patients.After anesthesia induction,PVB was performed at T5-T7 levels in Group one,ICNB was performed at T4-T9 levels in Group two and ESPB was performed at T5 level in Group three under ultrasound guidance with 20 ml 0.375% ropivacaine.After surgery,all patients were connected to the patient controlled intravenous analgesia(PCIA)device for postoperative continuous analgesia.Primary outcome was cumulative morphine consumption at 24 h postoperatively.Secondary results included total dosages of remifentanil and dexmedetomidine,VAS scores at rest and coughing at 0,2,4,8,24,48 h postoperatively,cumulative morphine consumption at other observed time and the frequency of rescue analgesia within 48 h postoperatively.ResultsFinally,data analysis was performed on 72 patients.There was a significant difference in median [interquartile range,IQR] morphine cumulative consumption at 24 h postoperatively among the three groups(PVB,10.5[9-15] mg;ICNB,18 [13.5-22.1] mg;ESPB,22[15-25.1] mg;P=0.000).Further analysis showed that difference was statistically significant for PVB group vs ICNB group(median difference,-6;95%CI,-9 to-3;P=0.001)and PVB group vs ESPB group(median difference,-7.5;95%CI,-12 to-4.5;P=0.000),but not for ICNB group vs ESPB group(median difference,-3;95%CI,-6 to 1.5;P=0.192).There was no significant difference in the total dosage of remifentanil and dexmetomidine among the three groups(P>0.05).The median VAS scores of the three groups at all postoperative time points were all less than 4(adequate analgesia).PVB group had significantly lower VAS scores than ESPB group at 0,2,4,8h postoperatively and than ICNB group at 8h postoperatively(P<0.0167).There was no significant difference in the VAS scores between ICNB group and ESPB group(P>0.0167).In addition,more rescue analgesia was needed in ESPB group during 48 postoperative hours(PVB vs ICNB vs ESPB;13% vs 29% vs 46%;P<0.05).ConclusionUltrasound-guided paravertebral nerve block provided superior analgesia for thoracoscopic surgery to intercostal nerve block and erector spinae plane block,while there was no significant difference in analgesic effect between intercostal nerve block and erector spinae plane block.