Erector Spinae Plane vs. Paravertebral Nerve Block for Thoracic Surgery
Status:
Recruiting
Trial end date:
2021-12-31
Target enrollment:
Participant gender:
Summary
Continuous paravertebral analgesia and erector spinae plane blockade (ESP) are accepted
techniques at University of Pittsburgh Medical Center (UPMC) for the management of thoracic
pain following surgery and trauma. Recently, an increasing number of erector spinae plane
nerve blocks are being performed as it has been demonstrated in our institution, and via case
reports that the blocks provide clinical effectiveness, but may have a better side-effect
profile than the paravertebral nerve block. However, the relative efficacy of ESP compared to
paravertebral nerve block remains to be established for video assisted thoracoscopic surgery
(VATS). This is a prospective randomized study intended to assess the efficacy, safety and
side-effect profile of continuous erector spinae plane analgesia versus continuous
paravertebral analgesia for VATS procedures. It will include 60 patients presenting to UPMC
Passavant for a VATS procedure. Patients will be randomized 1:1 to receive either a nerve
block via continuous paravertebral infusion or via erector spinae plane infusion. In
addition, to treat breakthrough pain, the patients in both arms will receive multimodal
adjunctive therapy per routine. Bupivacaine and ropivacaine are FDA approved for use in nerve
block catheters. The primary outcome will be to compare analgesic efficacy between the two
nerve blocks as defined by total opioid consumption and pain scores on the numeric pain
rating scale. Secondary outcomes include incentive spirometer amounts (baseline vs daily
score postoperatively), length of stay, duration of catheter and report of adverse events or
complications. Other data points include number of chest tubes and location and level of
catheter and nerve block placement as well as number of blocks per case.