Comparison of erector spinae plane blocks and intercostal blocks for postoperative analgesia after video-assisted thoracoscopic surgery: A randomized trial

Objectives To compare the efficacy of preoperative ultrasound-guided erector spinae plane (ESP) blocks and intraoperative intercostal blocks for postoperative analgesia after video-assisted thoracic surgery (VATS). Hypothesis: ESP blocks are superior to intercostal blocks. Design Prospective, randomized, single-blinded (outcome assessors) clinical trial. Setting University hospital. Participants 105. Interventions 37 subjects received ESP blocks with liposomal bupivacaine (Group ESP with LB admixture), 35 subjects received ESP blocks with plain bupivacaine (Group ESP plain bupivacaine), and 33 subjects received intercostal blocks with liposomal bupivacaine (Group Intercostal). Measurements and main results The primary outcome was visual analog scale (VAS) pain scores at 24- and 48-hours postoperatively. Secondary outcomes included VAS scores at 1 and 72 h as well as opioid usage, nausea, and sedation scores at 1, 24, 48, and 72 h, plus patient satisfaction scores at 24 and 48 h. An exploratory outcome compared VAS scores and opioid usage at 1, 24, 48, and 72 h between a combined group of all ESP subjects and group Intercostal. Group Intercostal was superior to both ESP groups at 24 h and superior to Group ESP plain bupivacaine at 48 h. There were no differences between Group ESP with LB admixture and Group ESP plain bupivacaine in the primary and secondary outcomes. The combined ESP group had higher pain scores with movement and higher opioid consumption than the SI group at 1 and 24 h. Conclusions Intercostal blocks provided superior analgesia after VATS compared with ESP blocks. Liposomal bupivacaine did not confer additional benefit over plain bupivacaine in ESP blocks.