Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study

Abstract

Background The optimal modality for postoperative analgesia after uniportal video-assisted thoracoscopic surgery (UVATS) for the treatment of lung cancer has not yet been determined. Both ultrasound-guided paravertebral block (PVB) and retrolaminar block (RLB) have been reported to be successful in providing analgesia after UVATS. However, which block technique provides superior analgesia after UVATS is still unclear. This randomized study was designed to compare the postoperative analgesic effects and adverse events associated with ultrasound-guided PVB and RLB after UVATS. Methods Sixty patients with lung cancer were randomized to undergo ultrasound-guided PVB (group P) or ultrasound-guided RLB (group R). In group P, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided PVB (15 mL at each level on the operative side). In group R, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided RLB (15 mL at each level on the operative side). The primary outcome was the numerical rating scale (NRS) score within 48 h after surgery. The secondary outcomes were total postoperative sufentanil consumption, time to first analgesic request and adverse events. Results At 3, 6, 12, 24, 36 and 48 h postoperatively, the NRS score at rest in group P was lower than that in group R (p < 0.05). At 3, 6, 12, 24 and 36 h postoperatively, the NRS score while coughing in group P was lower than that in group R (p < 0.05). The total postoperative sufentanil consumption in group P was significantly lower than that in group R (p < 0.001). Additionally, the time to first analgesic request was longer in group R than in group P (p < 0.0001). The incidence of nausea in group R was higher than that in group P (p < 0.05). Conclusions In patients with lung cancer undergoing UVATS, ultrasound-guided PVB with 0.5% ropivacaine provides better analgesia and results in less nausea than ultrasound-guided RLB. Compared with ultrasound-guided RLB, ultrasound-guided PVB seems to be a better technique for analgesia in UVATS. Trial registration The name of this study is the Effect And Mechanism Of Ultrasound-guided Multimodal Regional Nerve Block On Acute And Chronic Pain After Thoracic Surgery. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100044060). The date of registration was March 9, 2021.

The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study

“…Zhao et al [ 22 ] found that the analgesic effects of TRLB were superior to those of erector spinae blocks in patients with multiple rib fractures. Wang et al [ 9 ] compared ultrasound-guided TRLBs and paravertebral blocks for postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery and found that the paravertebral block resulted in better analgesia than the TRLB. In contrast, Hwang et al [ 23 ] conducted a randomized placebo study that aimed to assess the analgesic efficacy of a single injection of ultrasound-guided TRLB after breast surgery and reported that TRLB did not reduce postoperative analgesic consumption.…”

“…Ultrasound-guided thoracic retrolaminar block (TRLB) is a relatively new regional analgesic block that can be used as an alternative to the thoracic paravertebral block as a component of multimodal analgesia to control postoperative pain [ 5 ]. In adults, the analgesic efficacy of TRLB has been reported for rib fractures [ 6 ], breast surgery [ 7 , 8 ], and video-assisted thoracoscopic surgery [ 9 ]. Injecting a local anesthetic in the retrolaminar space blocks the ventral and dorsal rami of the thoracic spinal nerves and spreads laterally in the fascial plane to block the lateral cutaneous branch of the intercostal nerve and the small branches arising from it [ 5 ].…”

Efficacy of ultrasound-guided erector spinae plane block versus paravertebral block for postoperative analgesia in single-port video-assisted thoracoscopic surgery: a retrospective study

“…The length and number of incisions are less than that of the conventional approach of VATS. Therefore, anatomical structures such as muscles, nerves, and blood vessels are exposed to less trauma and clinically less postoperative pain is provided (13)(14)(15). This study was conducted to compare the postoperative analgesic efficacy of single-injection TPVB and ESPB in uniportal VATS.…”

Anatomical classification and clinical application of thoracic paraspinal blocks

“…Furthermore, a single injection of an RLB was found to provide analgesia lasting only 2–3 h after breast surgery, which is a much shorter period than that reported for the PVB [ 39 ]. Additionally, in thoracoscopic surgery, PVBs provide better analgesia and result in less nausea than RLBs [ 28 ].…”

“…Moreover, contra-indications to thoracic epidural analgesia do not preclude PVBs in most cases. For thoracic surgeries, such as thoracotomies, PVBs provide better postoperative analgesia and lower opioid consumption than ESP blocks and RLBs [26][27][28]. Although conflicting results have been reported for breast cancer surgery [29], the analgesic efficacy of PVBs was found to be superior to that of ESP and other truncal blocks [7].…”