Comparing erector spinae plane (ESP) and thoracic paravertebral (TPV) block analgesic effect after elective video-assisted thoracic surgery: a randomized, multiple-blinded, non-inferiority trial.

Background: Video-assisted thoracic surgery (VATS) is the gold standard for minimally invasive lung resections. Postoperative pain from VATS can hinder breathing and increase complications. Thoracic epidural analgesia (TEA) is effective but invasive. Less invasive options like thoracic paravertebral (TPV) block and erector spinae plane (ESP) block are being explored. This study compares ESP and TPV in a randomized, non-inferiority trial, focusing on opioid consumption post-VATS. Methods: This single-center, randomized, multiple-blinded, controlled, non-inferiority trial included 50 patients undergoing VATS at the Regional Hospital of Bellinzona and Valli (ORBV). Patients were randomized to receive either an ESP block with local anesthetic and a TPV block with saline (Anest ESP) or an ESP block with saline and a TPV block with local anesthetic (Sham ESP). The primary outcome was the cumulative dose of rescue opioids at 24 and 48 hours postoperatively. Results: Data from 47 patients were analyzed. There was no statistically significant difference in opioid consumption between the Anest ESP and Sham ESP groups at 24 hours (P=0.09) and 48 hours (P=0.12). In a sub-analysis by type of surgery, the NRS values were higher, as postulated, in major surgery. Cardiopulmonary complications and procedural times were low and comparable between groups. Conclusions: The study did not demonstrate the non-inferiority of the ESP block compared to the TPV block for postoperative analgesia following VATS. However, both blocks provided effective pain relief with no significant differences in outcomes. The findings suggest that both ESP and TPV blocks are viable alternatives to TEA.