Comparison of ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: a randomized controlled non-inferiority clinical trial

Background and objectives The anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS). Method In this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively. Results Eighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0-1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036). Conclusions The analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.