Comparison of Costotransverse Foramen Block with Thoracic Paravertebral Block and Erector Spinae Plane Block for Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Non-Inferiority Trial.

Purpose: This study aimed to investigate the safety and efficacy of costotransverse foramen block for postoperative analgesia in video-assisted thoracoscopic surgery (VATS). Patients and Methods: Seventy-five patients undergoing elective VATS under general anaesthesia were recruited to this double-blind, non- inferiority trial and randomized to preoperatively receive a thoracic paravertebral block (TPVB group), a costotransverse foramen block (CTFB group), or an erector spinae plane block (ESPB group) with 0.5% ropivacaine 20 mL at T5 level. The primary outcome was the postoperative numerical rating scale pain score assessed at 6 h. Secondary outcomes included pain scores at other time points, total opioids consumption at 24 h postoperatively, time to first patient-controlled analgesia pump bolus, number of patients requiring rescue analgesia, dermatomal coverage at 30 min after block, time to perform the block, satisfaction scores of the analgesic effect, block-related side effects, and other complications. The health-related quality of life was evaluated one month after surgery. Results: The pain scores at 6 h after surgery were 0 (0, 3) in the TPVB group, 0 (0, 2) in the CTFB group, and 4 (3, 4) in the ESPB group. The 95% CI of median difference was 0 to 0 comparing CTFB with TPVB and -4 to -2 comparing CTFB with ESPB. Both the upper 95% CI limits were lower than the predefined noninferiority margin of 1. The pain scores at postanaesthesia care unit, 1 h, 6 h and 12 h after surgery, number of block dermatomes, patient satisfaction scores, time to perform the block as well as the time to first analgesia pump bolus were significantly different between the CTFB group and ESPB group. No differences were detected in other secondary outcomes. Conclusion: Ultrasound-guided CTFB provided noninferior analgesia compared to TPVB at 6 h after VATS. Additionally, CTFB might provide better analgesia to ESPB although larger confirmatory researches for superiority are further warranted.