A Comparative Study Between Ultrasound-Guided Erector Spinae Plane Block and Paravertebral Block in Thoracic Surgeries For Postoperative Analgesia

Background: Regional analgesia has an important role in the multimodal analgesia approach for postoperative pain management. Recently, the use of PVB is increased for providing effective analgesia. ESP block is a comparatively newer modality, established as a good analgesic technique. This study aimed to compare the postoperative analgesic efficacy of ultrasound-guided ESP block and PVB in thoracic surgeries.
Materials and Methods: This prospective randomized comparative open-label study involved 60 patients who underwent different thoracic surgeries and were randomized to receive ultrasound-guided ESP block (group A) or PVB (group B) with 20 ml 0.25% bupivacaine before induction of general anesthesia. Postoperatively, all patients received 1gm intravenous paracetamol injection every 8 hours. The primary outcome was to compare VAS scores at 0, 1, 3, 6, 12, and 24h, and secondary outcomes were assessed in terms of analgesic consumption and hemodynamic stability postoperatively
Results: Group A had a significantly lower VAS score at 0h, 1h, 3h, and 6h postoperatively (p=0.026, 0.003, 0.003, and 0.002, respectively) than group B. Thereafter, comparable VAS scores were found at 12 and 24h. However, the mean VAS in either of the group was <4 postoperatively. Rescue analgesic consumption was found comparable (p>0.05) in both groups. All patients exhibited stable hemodynamic profiles postoperatively.
Conclusion: Ultrasound-guided ESP block along with round-the-clock NSAIDs can be a better and safe alternative to PVB in thoracic surgeries with reduced analgesic consumption and hemodynamic stability.