Application of erector spinae plane block and thoracic paravertebral block in thoracoscopic lobectomy

Compare the effects of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) in perioperative pain management for thoracoscopic lobectomy.

From September 2024 to June 2025, 99 patients with pulmonary space-occupying lesions scheduled for thoracoscopic lobectomy were enrolled and randomly assigned to three groups (33 each): the control group, the ESPB group, and the TPVB group. Baseline data covered gender, age, body mass index, tumor-node-metastasis stage, American Society of Anesthesiologists grade, surgery duration, and resection site. Primary outcomes were resting and coughing visual analogue scale (VAS) scores in the postanesthesia care unit at 2, 4, 8, 16, and 24 h postoperatively. Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), adverse reactions, opioid consumption, time to first ambulation, hospital stay, and drainage tube duration.

Baseline data were comparable. ESPB and TPVB groups had lower VAS scores and area under curve (AUC) than the control group (p < 0.05), with TPVB showing the best results (p < 0.05). The control group had higher postoperative MAP and HR than the other two groups (p < 0.05), while the TPVB group had lower MAP and HR than the ESPB group at 2 and 4 h post-surgery (p < 0.05). Adverse reaction rates were similar across groups (p > 0.05). The TPVB group also surpassed the ESPB and control groups in opioid consumption, time to first ambulation, hospital stay, and drainage tube duration (p < 0.05). The pain level of patients was positively correlated with the time of first getting out of bed, the duration of hospitalization and the duration of drainage tube (p < 0.05).

Both TPVB and ESPB can effectively relieve postoperative pain, reduce stress responses, and shorten recovery time after thoracoscopic lobectomy. TPVB offers better early analgesia and hemodynamic stability.

www.chictr.org.cn, Identifier, ChiCTR2100054074, 2021/12/08.