Postoperative recovery with continuous erector spinae plane block or video-assisted paravertebral block after minimally invasive thoracic surgery: a prospective, randomised controlled trial

被引:56
作者
Moorthy, Aneurin [1 ,2 ]
Ni Eochagain, Aisling [3 ]
Dempsey, Eamon [3 ]
Wall, Vincent [1 ]
Marsh, Hannah [3 ]
Murphy, Thomas [1 ]
Fitzmaurice, Gerard J. [4 ]
Naughton, Rory A. [3 ]
Buggy, Donal J. [1 ,2 ,5 ,6 ]
机构
[1] Mater Misericordiae Univ Hosp, Div Anaesthesiol, Dublin, Ireland
[2] Univ Coll, Sch Med, Dublin, Ireland
[3] St James Univ Hosp, Dept Anaesthesiol, Dublin, Ireland
[4] St James Univ Hosp, Dept Cardiothorac Surg, Dublin, Ireland
[5] ESA IC Oncoanaesthesiol Res Grp, EuroPeriscope, Brussels, Belgium
[6] Cleveland Clin, Outcomes Res, Cleveland, OH USA
关键词
chronic postsurgical pain; erector spinae plane block; minimally invasive thoracic surgery; paravertebral block; quality of recovery; regional anaesthesia; video-assisted thoracic surgery; LUNG-CANCER; REGIONAL ANALGESIA; PAIN; ULTRASOUND; QUALITY; CLASSIFICATION; EXPERIENCE; VATS;
D O I
10.1016/j.bja.2022.07.051
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) guidelines recommend erector spinae plane (ESP) block or paravertebral block (PVB) for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). However, there are few trials comparing the effectiveness of these techniques on patient-centric outcomes, and none evaluating chronic postsurgical pain (CPSP). Furthermore, there are no available trials comparing ultrasound -guided ESP with surgically placed PVB in this patient cohort. Methods: We conducted a two-centre, prospective, randomised, double-blind, controlled trial, comparing anaesthesiologist-administered, ultrasound-guided ESP catheter with surgeon-administered, video-assisted PVB catheter analgesia among 80 adult patients undergoing VATS. Participants received a 20 ml bolus of levobupivacaine 0.375% followed by infusion of levobupivacaine 0.15% (10-15 ml h-1) for 48 h. Primary outcome was Quality of Recovery-15 score (QoR-15) at 24 h. Secondary outcomes included QoR-15 at 48 h, peak inspiratory flow (ml s-1) at 24 h and 48 h, area under the pain verbal response score vs time curve (AUC), opioid consumption, Comprehensive Complication Index, length of stay, and CPSP at 3 months after surgery.Results: Median (25-75%) QoR-15 at 24 h was higher in ESP (n=37) compared with PVB (n=37): 118 (106-134) vs 110 (89-121) (P=0.03) and at 48 h: 131 (121-139) vs 120 (111-133) (P=0.03). There were no differences in peak inspiratory flow, AUC, Comprehensive Complication Index, length of hospital stay, and opioid consumption. Incidence of CPSP at 3 months was 12 (34%) for ESP and 11 (31%) for PVB (P=0.7).Conclusions: Compared with video-assisted, surgeon-placed paravertebral catheter, erector spinae catheter improved overall QoR-15 scores at 24 h and 48 h but without differences in pain or opioid consumption after minimally invasive thoracic surgery.Clinical trial registration: NCT04729712.
引用
收藏
页码:e137 / e147
页数:11
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