• Pedro Hilton de Andrade Filho, Victor Egypto Pereira, Daniel da Escossia Melo Sousa, Ladyer da Gama Costa, Yuri Pinto Nunes, Giovani Taglialegna, Waynice Neiva de Paula-Garcia, and Joao Manoel Silva.
• Department of Anaesthesiology, Hospital do Servidor Publico Estadual de São Paulo, São Paulo, Brazil.
• Acta Anaesthesiol Scand. 2024 Jan 1; 68 (1): 717971-79.

BackgroundPain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non-inferiority of the analgesia provided by ESPB when compared to paravertebral block (PVB) in lung surgeries.MethodsRandomised, active-controlled, blinded for patients and assessors, non-inferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique-continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score ≥ 7 was considered analgesia failure, and the prespecified non-inferiority margin was 10%.ResultsIn the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 ± 3.2 in the ESPB group versus 3.9 ± 2.9 in the PVB group, with a difference of -0.67 (-15.2%) and 95%CI: -1.29 to -0.05 (p = .02), demonstrating not non-inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p < .01) and required more postoperative opioids (p = .01 over 24 h). There was no difference in patient satisfaction between groups.ConclusionThis trial demonstrated that a continuous erector spinae plane block was not non-inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption.© 2023 Acta Anaesthesiologica Scandinavica Foundation.

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