From regional blocks to postoperative outcomes: Exploring the correlation between intraoperative hypotension and short-term postoperative outcomes in thoracic surgery

Video-assisted thoracic surgery (VATS) provides benefits such as fewer complications and shorter hospital stays, but postoperative pain remains a challenge. While thoracic epidural block (TEB) was once the standard, concerns over risks have shifted interest toward thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB). This study compares ESPB and TPVB, focusing on intraoperative hypotension (IOH), and its impact on hemodynamic stability. In this single-center, prospective, placebo-blinded trial, 50 elective VATS patients were randomized to receive either sham TPVB with active ESPB or sham ESPB with active TPVB at T5. The primary outcome was IOH, defined as a 20% decrease in systolic blood pressure from induction to incision. Secondary outcomes included norepinephrine use, nausea and vomiting, and procedural duration. Statistical analyses were performed using chi-square and paired t-tests (p < 0.05). Among 47 analyzed patients, IOH occurred in 14 patients in the ESPB group and 12 patients in the TPVB group (p=0.671). Norepinephrine perfusors were required on only three occasions, indicating a low incidence of severe or refractory intraoperative hypotension. Nausea and vomiting showed no significant differences, while TPVB took significantly longer to perform than ESPB (p = 0.025). ESPB appears to be a viable alternative to TPVB in VATS, offering a technically simpler approach without compromising intraoperative hemodynamic stability. However, further studies with larger sample sizes are necessary to fully understand ESPB’s mechanisms and clinical implications.