• Minke L Feenstra, Cezanne D Kooij, Wietse J Eshuis, Eline M de Groot, Jeroen Hermanides, B Feike Kingma, Suzanne S Gisbertz, Jelle P Ruurda, Freek Daams, Marije Marsman, Oscar F C van den Bosch, Werner Ten Hoope, Lucas Goense, LuyerMisha D PMDPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., NieuwenhuijzenGrard A PGAPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Harm J Scholten, Marc Buise, Marc J van Det, Ewout A Kouwenhoven, Franciscus van der Meer, Geert W J Frederix, Markus W Hollmann, Edward Cheong, Mark I van Berge Henegouwen, and Richard van Hillegersberg.
• Department of Surgery, Amsterdam UMC location University of Amsterdam, AGEM, Cancer Center Amsterdam, Amsterdam, the Netherlands.
• Ann. Surg. 2024 Oct 3.

ObjectiveTo compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).Summary Background DataParavertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.MethodsThis randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality.ResultsFrom December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay.ConclusionsThis randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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