Comparative characteristics of regional anesthesia methods in thoracic surgery: randomized, prospective, open-label, controlled trial

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Abstract

OBJECTIVE: To compare and analyze the effectiveness of regional anesthesia methods in thoracic surgery.

MATERIALS AND METHODS: A total of 150 patients were examined, 75 each underwent thoracotomy and surgery with video-assisted thoracoscopic surgery (VATS) access. Depending on the type of regional anesthesia, patients were divided into one of these five groups: epidural blockade (EB) group (n=30), paravertebral blockade (PVB) group (n=30), erector spinae plane (ESP) block group (n=30), serratus anterior plane (SAP) block group (n=30), and control (group 5, only systemic anesthesia was used, n=30). The intensity of postoperative pain syndrome, need for promedol and tramadol, and incidence of atelectasis and hypotension were assessed. The length of stay in the intensive care unit (ICU) was recorded.

RESULTS: The median pain value during thoracotomy was the lowest in the EB group. In the ESP and SAP block groups, the pain syndrome was more pronounced and corresponded to the median values of the control group. EB and PVB with VATS access had the maximum analgesic effect, and the median values of the pain syndrome during ESP and SAP blocks made it possible to reduce the intensity of the pain syndrome relative to the control group. The EB and PVB groups generally did not require promedol postoperatively. All patients with thoracotomy in the ESP block, SAP block, and control groups used narcotic opioids. With VATS access, in the ESP and SAP block groups and control group, all patients receiving analgesic therapy used a narcotic analgesic. In the control group, FBS was performed more often in absolute terms; however, no significant differences were found (p=0.227, χ2 test). Arterial hypotonia in the EB group was significantly more common than that in patients with other anesthesia types (p=0.0164, chi-square test). The control group recorded the highest number of days of patient stay in the ICU (Me [thoracotomy], 3 days; Me [VATS], 2 days). In the control group, only the EB (Me [thoracotomy], 2 days; Me [VATS], 1 day, p=0.022, χ2 criterion) and PVB (Me [thoracotomy], 2 days; Me [VATS], 1 day, p=0.008, χ2 criterion) reduced the length of ICU stay.

CONCLUSION: With thoracotomy, the choice remains between epidural or paravertebral anesthesia. EB more often than others causes arterial hypotension. In VATS access, ESP and SAP blocks can be alternatives to neuraxial methods. During the ESP block, catheterization can reduce pain intensity compared with those without it. EB and PVB can reduce the length of ICU stay.

About the authors

Vasiliy A. Zhikharev

Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1; Kuban State Medical University

Author for correspondence.
Email: Vasilii290873@mail.ru
ORCID iD: 0000-0001-5147-5637
SPIN-code: 7406-7687

MD, Dr. Sci. (Med.), senior resident

Russian Federation, Krasnodar; Krasnodar

Alexandr S. Bushuev

Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1

Email: Vasilii290873@mail.ru
ORCID iD: 0000-0002-1427-4032
SPIN-code: 3640-7080

MD, Cand. Sci. (Med.), medical resident

Russian Federation, Krasnodar

Victor A. Koriachkin

St. Petersburg State Pediatric Medical University

Email: Vasilii290873@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Vladimir A. Porkhanov

Scientific Research Institution – Ochapovsky Regional Clinic Hospital No. 1; Kuban State Medical University

Email: Vasilii290873@mail.ru
ORCID iD: 0000-0003-0572-1395
SPIN-code: 2446-5933

MD, Dr. Sci. (Med.), Professor, Academician of RAS, chief physician, Honored doctor of Russia

Russian Federation, Krasnodar; Krasnodar

Vladimir A. Glushchenko

Petrov National Medical Research Center of Oncology

Email: Vasilii290873@mail.ru
ORCID iD: 0000-0003-2638-5853
SPIN-code: 1274-9977

MD, Dr. Sci. (Med.), Professor, head of scientific department

Russian Federation, St. Petersburg

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Surgery duration depending on its type.Note (here and in Fig. 2–6). ЭБ — epidural block, ПВБ — paravertebral block, ESP — erector spine plane block, SAP — serratus anterior plane block.

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3. Fig. 2. Pain syndrome dynamics during operations by thoracotomy access.

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4. Fig. 3. Pain syndrome dynamics during VATS-access operations.

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5. Fig. 4. Pain intensity during coughing and physical activity within 48 h after surgery.Note. ЦРШ — Numerical Rating Scale.

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6. Fig. 5. Promedol postoperative consumption in the first 24 h.

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7. Fig. 6. Tramadol postoperative consumption in the first 24 h

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Copyright (c) 2022 Zhikharev V.A., Bushuev A.S., Koriachkin V.A., Porkhanov V.A., Glushchenko V.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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