Comparison of Ultrasound-Guided Single-Injection Erector Spinae Plane Block, Retrolaminar Block, and Paravertebral Block for Postoperative Analgesia in Single-Incision Video-Assisted Thoracoscopic Surgery: A Three-Arm, Double-Blind, Randomized Controlled Non-Inferiority Trial

Abstract Objective:This study aims to compare the analgesic efficacy of erector spinae plane block (ESPB), retrolaminar block (RLB), and paravertebral block (TPVB) in single-incision video-assisted thoracoscopic surgery (VATS). Additionally, ESPB and RLB are investigated as potential secondary options in cases where TPVB is contraindicated or unsuccessful.Methods：A total of 76 patients underwent general anesthesia induction followed by nerve block under ultrasound guidance, with 20 ml of 0.5% ropivacaine administered to each. Recorded parameters included NRS scores' AUC during rest and coughing over the first 24 postoperative hours, preoperative and postoperative (24h and 48h) plasma biomarker levels, perioperative opioid consumption, time to first postoperative analgesic use, arterial blood gas analysis, white blood cell count (WBC), high-sensitivity C-reactive protein (hs-CRP), QoR-15 scores, incidence of postoperative nausea and vomiting (PONV), time to bowel function recovery, length of hospital stay (LOS), and adverse events.Results:The AUC for Group E (107.8±10.53) and R (104.8±8.05) compared to P (103.6±10.42) had differences of 4.2±3.0 (95% CI -1.82 to 10.22) and 1.2±2.6 (95% CI -3.97 to 6.37), respectively, with lower limits of the 95% confidence interval (CI) exceeding the non-inferiority margin. IL-6, IL-8, IL-1β, TNF-α at 24 and 48h postoperatively showed no significant differences. At 24h, IL-10 levels were comparable, and at 48h, group T exhibited higher IL-10 levels than group E. There were no statistical differences in QoR-15 scores, perioperative opioid consumption, time to first postoperative analgesic use, WBC, hs-CRP, Glu, and Lac levels, time to bowel function recovery, and LOS (P>0.05). The time from block completion to incision showed no statistical differences (P=0.996), but four cases in Group E experienced hypertension during incision, one in Group R, and none in Group P (P=0.047). Regarding adverse events, one patient each in Groups P and R experienced hypotension, while no patients in Group E experienced hypotension (P=0.142). No cases of PONV or other complications were observed.Conclusion:ESPB and RLB can provide analgesic effects for VATS patients that are non-inferior to TPVB, with the added benefit of improved safety. They represent effective alternative options to TPVB.Trial registration:Chinese Clinical Trial Register (identifier: ChiCTR2300069985).