Continuous Ultrasound-Guided Erector Spinae Plane Block Versus Thoracic Paravertebral Block for Postoperative Analgesia in Patients Undergoing Thoracotomy

Objectives: To compare postoperative analgesia using continuous ultrasound-guided Erector spinae plane block versus Thoracic Paravertebral Block, with dynamic visual analogue scale (VAS) during coughing as the primary outcome. Secondary outcomes included static VAS (at rest), hemodynamic changes, side effects, total opioid consumption, time of first rescue analgesia, length of hospitalization, anesthesia recovery time, Post-Anesthesia Care Unit stay, time to first ambulation, and patient satisfaction Methods: The study included 40 cases scheduled for elective thoracotomy admitted to the cardiothoracic surgery unit of Menoufia University Hospital. Subjects were equally randomized into two groups 20 patients each receiving either ultrasound guided Erector Spinae Plane Block ESPB or Thoracic Paravertebral Block TPVB (control group). Both groups received 20 mL of 0.25% bupivacaine as a loading dose followed by continuous infusion of 0.125% bupivacaine at 5 mL/h, with patient-controlled boluses of 20 mL on demand. Results: Dynamic Visual Analogue Scale scores were significantly lower in the ESPB group at 6, 9, 12, and 24 hours ( P =0.008, 0.035, 0.001, 0.006). Morphine consumption was significantly reduced in the ESPB group ( P <0.001). Hypotension was more frequent in TPVB (40% vs 10%, P =0.028). No significant differences were observed in hospital stay or patient satisfaction. Discussion: The utilization of continuous ultrasound-guided ESPB demonstrated better postoperative Visual Analogue Scale scores significant decrease in opioid consumption, with fewer side effects than TPVB.