Thoracic Paravertebral Block Versus Erector Spinae Plane Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Surgery: A Retrospective Cohort Study
Özlem Turhan1, Nükhet Sivrikoz1, Zerrin Sungur1, Esra Saka1, Müşerref Beril Dinçer1, Mert Şentürk21Department of Anesthesiology and Reanimation, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Türkiye2Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Türkiye
Objectives: Thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) are widely utilized regional analgesia techniques for video-assisted thoracoscopic surgery (VATS). However, evidence comparing their analgesic efficacy remains inconclusive. This study aimed to compare postoperative opioid requirements, pain scores, rescue analgesic requirements, and perioperative outcomes between TPVB and ESPB in patients undergoing VATS.
Methods: Patients who underwent VATS between January 2021 and December 2025 were retrospectively evaluated. A total of 424 patients were analyzed (TPVB group, n=247; ESPB group, n=177). The primary outcome was additional postoperative intravenous (IV) morphine consumption in the post-anesthesia care unit (PACU). Secondary outcomes included rescue tramadol requirements, Numerical Rating Scale (NRS) pain scores, perioperative hemodynamics, and complications.
Results: Additional PACU IV morphine consumption was significantly lower in the TPVB group compared with the ESPB group (4.02±0.97 mg vs. 4.48±1.16 mg, p<0.001). The proportion of patients requiring rescue tramadol was also lower in the TPVB group (21.1% vs. 31.6%, p=0.014). Patients in the TPVB group had significantly lower NRS scores on arrival at the PACU and at 1, 2, and 12 hours postoperatively, with no difference at 24 hours. No significant differences were observed regarding PACU stay, length of hospital stay, postoperative or block-related complications, or perioperative hemodynamic parameters.
Conclusion: TPVB was associated with lower PACU opioid consumption, reduced rescue analgesic requirements, and lower postoperative NRS scores compared with ESPB; however, the absolute differences were relatively small, and their clinical relevance may be limited.
Keywords: Erector spinae plane block, postoperative analgesia, thoracic paravertebral block, video-assisted thoracoscopic surgery
Manuscript Language: English
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