Erector spinae plane versus paravertebral versus multiple intercostal nerve blocks in patients undergoing vats; A randomized controlled trial

Background: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique with shorter recovery times and lesser postoperative pain than open thoracotomies. Regional blocks decrease the anesthetic and postoperative analgesic requirements. Methods: 105 patients scheduled for VATS under general anesthesia were included. Patients were randomly allocated to receive 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by ultrasound-guided erector spinae plane block (ESPB) at T5 level (Group ESPB, n = 35), 20 ml of bupivacaine 0.5% mixed with adrenaline 2 mcg/ml by paravertebral block (PVB) at T5 level (Group PVB, n = 35), or multiple intercostal nerve blocks (Group MICNB, n = 35) where 2-3 ml of bupivacaine 0.5% mixed with adrenaline 2 mcg/ml for each intercostal space from the third to the eighth intercostal nerve were injected by the surgeon through the thoracoscope. The objectives of this study were primarily to assess the effectiveness of the erector spinae plane versus paravertebral versus multiple intercostal nerve blocks on the intraoperative patient anesthetic requirements and secondarily to assess the postoperative analgesic requirements. Results: No significant differences were observed regarding End tidal Sevoflurane (Et Sevo) all over the operative time between the ESPB and the PVB group; however there were highly significant differences between either group and the MICNB group immediately after induction of anesthesia till 60 min later, No significant difference between ESPB and the PVB groups as regards to the total amount of intraoperative fentanyl consumption, on the other hand there were highly significant difference between the ESPB or the PVB group and the MICNB group; while all the three groups provide comparable postoperative analgesia with non-significant difference regarding the postoperative VAS either during rest or cough. Conclusion: ESPB and PVB provided better intraoperative anesthetic sparing effect than MICNB; however all the three blocks provide comparable postoperative analgesia either during rest or during cough in patients undergoing VATS.