Erector spinae plane block added to intercostal nerve block versus intercostal nerve block alone for postoperative analgesia in video-assisted thoracoscopic surgery: A randomized controlled trial.
Hyerim Kim, Dongwook Won, Jee-Eun Chang et al.
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In 30 seconds
This prospective, randomized controlled trial compared surgical intercostal nerve block (INB) alone with INB plus single-injection erector spinae plane block (ESPB) in 60 adults undergoing elective three-port video-assisted thoracoscopic surgery. The primary outcome, pain intensity at 1 hour, was similar between groups: Numerical Rating Scale scores were 5.83 ± 2.86 with combined blocks and 5.52 ± 3.10 with INB alone (mean difference 0.31, 95% CI, -1.25 to 1.87; p = 0.691). Twenty-four-hour opioid consumption was also not significantly different. The trial found no significant additional analgesic benefit from adding ESPB.
Key findings
- At 1 hour, pain scores were 5.83 ± 2.86 with ESPB plus INB and 5.52 ± 3.10 with INB alone (mean difference 0.31, 95% CI, -1.25 to 1.87; p = 0.691).
- Twenty-four-hour opioid consumption was 41.0 mg (IQR, 31.0-58.5) versus 40.0 mg (IQR, 29.1-48.3) in intravenous morphine equivalents (between-group difference, 3.0 mg; 95% CI, -6.2 to 12.0; p = 0.501).
- Postoperative pain trajectories through 48 hours showed no significant group-by-time interaction (F[7, 401.2] = 0.81, p = 0.581).
Why it matters
Regional analgesic techniques are used to manage pain after thoracoscopic surgery, and adding a block may increase procedural complexity. In this trial, the combined approach did not improve the measured pain or opioid outcomes over INB alone. The findings help frame expectations for this specific combination while leaving open whether smaller benefits might be detected in a larger study.
What to keep in mind
The trial included 60 patients, and the authors state that larger adequately powered studies are needed to assess smaller clinically relevant benefits.