Key result
TEA and TPVB linked to up to ~95 mg lower intraoperative opioid use vs general anesthesia alone.
Why the study?
The optimal regional block options for intraoperative opioid minimization in patients undergoing video-assisted thoracoscopic surgery remain unclear.
Does regional block (TEA, TPVB, or SAPB) reduce intraoperative opioid consumption in adults undergoing video-assisted thoracoscopic surgery?
Cohort (n=168)
No
Does regional block (TEA, TPVB, or SAPB) reduce intraoperative opioid consumption in adults undergoing video-assisted thoracoscopic surgery?
Mean Difference: -78.45 (95% CI -141.34–-15.56)
Absolute Event Rate: 411% vs 512%
p-value: p=0.014
The use of thoracic epidural analgesia or thoracic paravertebral block, but not serratus anterior plane block, is associated with a significant intraoperative opioid-sparing effect during video-assisted thoracoscopic surgery.
Associated with intraoperative opioid sparing by TEA/TPVB in VATS; hypothesis-generating, requiring RCTs before practice change.
BACKGROUND: Regional block, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), or serratus anterior plane block (SAPB) has been recommended to reduce postoperative opioid use in recent guidelines, but the optimal options for intraoperative opioid minimization remain unclear. The aim of this study was to evaluate the intraoperative opioids-sparing effects of three regional blocks (TEA, TPVB, and SAPB) in patients undergoing video-assisted thoracoscopic surgery (VATs). METHODS: This was a retrospective study of the adults undergoing VATs at a tertiary medical center between January 2020 and February 2022. According to the type of regional block used, patients were classified into 4 groups: GA group (general anesthesia without any regional block), TEA group (general anesthesia combined with TEA), TPVB group (general anesthesia combined with TPVB), and SAPB group (general anesthesia combined with SAPB). Cases were matched with a 1:1:1:1 ratio for analysis by age, sex, ASA physical status, and operation duration. The primary outcome was the total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME). Multivariable linear regression was used to estimate the association of the three regional blocks with the OME. RESULTS: A total of 2159 cases met the eligibility criteria. After matching, 168 cases (42 in each group) were included in analysis. Compared with GA without any reginal block, the use of TEA, TPVB, and SAPB reduced the median of intraoperative OME by 78.45 mg (95% confidence interval [CI], -141.34 to -15.56; P=0.014), 94.92 mg (95% CI, -154.48 to -35.36; P=0.020), and 11.47mg (95% CI, -72.07 to 49.14; P=0.711), respectively. CONCLUSIONS: The use of TEA or TPVB was associated with an intraoperative opioid-sparing effect in adults undergoing VATs, whereas the intraoperative opioid-sparing effect of SAPB was not yet clear.
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Yan et al. (2022) conducted a cohort in Video-assisted thoracoscopic surgery (VATS) (n=168). Thoracic epidural analgesia (TEA) vs. General anesthesia without regional block was evaluated on Total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME) (MD -78.45 mg, 95% CI -141.34 to -15.56, p=0.014). Thoracic epidural analgesia and thoracic paravertebral block reduced intraoperative opioid consumption by 78.45 mg and 94.92 mg of oral morphine equivalents, respectively, compared to general anesthesia alone in patients undergoing video-assisted thoracoscopic surgery.
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