• van den BroekRenee J CRJC0000-0001-5939-695XDepartment of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands renee.vd.broek@catharinaziekenhuis.nl., Jonne M C Postema, Koopman... more Joseph S H AJSHADepartment of Anesthesiology and Pain Medicine, Maasstad Hospital, Rotterdam, The Netherlands., Charles C van Rossem, Jules R Olsthoorn, Thomas J van Brakel, Saskia Houterman, R Arthur Bouwman, and Barbara Versyck. less
• Department of Anesthesiology and Pain medicine, Catharina Hospital, Eindhoven, The Netherlands renee.vd.broek@catharinaziekenhuis.nl.
• Reg Anesth Pain Med. 2025 Jan 7; 50 (1): 111911-19.

Background And ObjectivesThe evolving surgical techniques in thoracoscopic surgery necessitate the exploration of anesthesiological techniques. This study aimed to investigate whether incorporating a continuous erector spinae plane (ESP) block into a multimodal analgesia regimen is non-inferior to continuous thoracic epidural analgesia (TEA) in terms of quality of postoperative recovery for patients undergoing elective unilateral video-assisted thoracoscopic surgery.MethodsWe conducted a multicenter, prospective, randomized, open-label non-inferiority trial between July 2020 and December 2022. Ninety patients were randomly assigned to receive either continuous ESP block or TEA. The primary outcome parameter was the Quality of Recovery-15 (QoR-15) score, measured before surgery as a baseline and on postoperative days 0, 1, and 2. Secondary outcome parameters included pain scores, length of hospital stay, morphine consumption, nausea and vomiting, itching, speed of mobilization, and urinary catheterization.ResultsAnalysis of the primary outcome showed a mean QoR-15 difference between the groups ESP block versus TEA of 1 (95% CI -9 to -12, p=0.79) on day 0, -1 (95% CI -11 to -8, p=0.81) on day 1 and -2 (95% CI -14 to -11, p=0.79) on day 2.ConclusionsThe continuous ESP block is non-inferior to TEA in video-assisted thoracoscopic surgery.Trial Registration NumberDutch Trial Register (NL6433).© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

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