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

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: 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.