Analgesic efficacy of continuous erector spinae plane block vs. opioid‐based regimen for postoperative pain management following video‐assisted thoracoscopic lung resection: a prospective, randomised, open‐label, non‐inferiority trial

Abstract

Summary Introduction Video‐assisted thoracoscopic lung resection causes significant postoperative pain. We hypothesised that continuous erector spinae plane block would provide non‐inferior analgesia compared with a conventional opioid‐based regimen for this procedure. Methods Patients were allocated randomly to continuous erector spinae plane block (continuous infusion of 0.25% ropivacaine via perineural catheters (5 ml.h ‐1 ) combined with programmed intermittent bolus (10 ml every 6 h for the initial 24 h)) or conventional opioid‐based regimen (continuous infusion of opioid (2 μg.kg ‐1 sufentanil and 16 mg ondansetron diluted to 100 ml with 0.9% normal saline) at 2 ml.h ‐1 for 48 h). The primary outcome was overall analgesic efficacy with cough, quantified by the cumulative area under curve for the pain numeric rating scale scores, from post‐anaesthesia care unit discharge to 48 h postoperatively. Results The cumulative area under curve for the pain numeric rating scale score in patients allocated to the continuous erector spinae plane block group was non‐inferior to those allocated to the conventional group (mean difference − 0.99, 95%CI ‐11.97–9.98, p = 0.011). Patients allocated to the continuous erector spinae plane block group showed superior quality of recovery‐15 scores at 24 h (median difference 11, 95%CI 6–16, p < 0.001) and 48 h postoperatively (median difference 10, 95%CI 7–15, p < 0.001), alongside reduced postoperative pulmonary complications (relative risk 0.45, 95%CI 0.21–0.96, p = 0.031). Safety outcomes favoured continuous erector spinae plane block, with lower incidences of postoperative nausea (relative risk 0.17, 95%CI 0.04–0.73, p = 0.005); retching (relative risk 0.11, 95%CI 0.02–0.89, p = 0.023); and dizziness (relative risk 0.22, 95%CI 0.07–0.72, p = 0.005). Discussion Following video‐assisted thoracoscopic lung resection, continuous erector spinae plane block provides non‐inferior postoperative analgesia compared with conventional opioid‐based regimen whilst enhancing recovery quality significantly and reducing complications.