• Chahyun Oh, Yooyoung Chong, Min-Woong Kang, Jaemun Bae, Soomin Lee, Yumin Jo, Jiyong Lee, Sujin Baek, Jinsik Jung, Yoon-Hee Kim, and Boohwi Hong.
• Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
• J Clin Anesth. 2023 Sep 1; 88: 111127111127.

Study ObjectiveThe present study assessed whether costotransverse foramen block (CTFB) is noninferior to thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS) pulmonary resection.DesignSingle-center, double-blinded, randomized, non-inferiority trial.SettingOperating room and intensive care unit or ward in a tertiary hospital.PatientsPatients aged 20 to 80 years with American Society of Anesthesiology physical status 1 to 3 scheduled for elective VATS pulmonary resection.InterventionsSixty patients were randomly allocated 1:1 to receive CTFB or TPVB using 15 mL aliquots of 0.5% ropivacaine at the T4-5 and T6-7 intercostal levels immediately after the induction of general anesthesia.MeasurementsThe primary outcome was the area under the curve (AUC) of numeric rating scale (NRS, 0 to 10) during 24 h postoperatively (noninferiority limit was 24; NRS 1 per hour). The secondary outcomes included postoperative opioid consumption, rescue analgesic use, postoperative nausea and vomiting, pulmonary function, dermatomal spread of the blockade, and quality of recovery.Main ResultsForty-seven patients were included for final analysis. The difference between the mean 24-h AUCs of NRS in the CTFB (34.25 ± 16.30, n = 24) and TPVB (39.52 ± 17.13, n = 23) groups was -5.27 (95% confidence interval [CI], -15.09 to 4.55), with the upper limit of 95% CI being far below the predefined noninferiority margin of 24. There was no significant difference in the dermatomal spread of the blockades between the groups, as both reached the upper and lower most levels of T3 and T7 (median). Additionally, there were no significant differences in other secondary outcomes between the two groups.ConclusionsThe analgesic effect of CTFB was noninferior to that of TPVB during 24 h postoperatively in VATS pulmonary resection. Moreover, CTFB may offer potential safety benefits by keeping the tip of the needle far from the pleura and vascular structure.Copyright © 2023 Elsevier Inc. All rights reserved.

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