Comparison of erector spinae plane block and paravertebral block on quality of recovery-15 after video-assisted thoracoscopic surgery: a prospective randomized study

BACKGROUND: Postoperative pain remains a significant concern after video-assisted thoracoscopic surgery (VATS), potentially impairing recovery quality. Thoracic erector spinae plane block (ESPB) and paravertebral block (PVB) are widely used regional anesthesia techniques integrated into multimodal analgesia protocols. This study compared their effects on postoperative recovery quality and pain control. METHODS: In this prospective randomized study, 60 adult patients undergoing elective VATS were allocated to receive either ESPB (n = 30) or PVB (n = 30) at the T4-T5 level under ultrasound guidance. The primary outcome was postoperative quality of recovery assessed by the validated Turkish version of the Quality of Recovery-15 (QoR-15) questionnaire. Pain intensity was measured using the Numeric Rating Scale (NRS). Additional outcomes included opioid consumption, length of hospital stay (LOS), rescue analgesia requirement, and complications. RESULTS: Preoperative QoR-15 scores were comparable between groups. At 24 h postoperatively, QoR-15 scores were significantly higher in Group PVB than in Group ESPB (139.40 ± 7.38 vs. 134.90 ± 8.70; p = 0.024; Cohen's d = 0.56), although the between-group difference did not reach the minimal clinically important difference. The decline in QoR-15 from baseline was greater in Group ESPB (- 11.50 [- 15.00 to - 8.00] vs. -7.50 [- 10.00 to - 4.00]; p = 0.001; r = 0.41). Longitudinal analysis of postoperative NRS scores demonstrated a significant group × time interaction (p = 0.001). Pain scores at postoperative 0 h were significantly lower in Group PVB (p = 0.002), whereas no significant between-group differences were observed at later time points (2-24 h). Opioid consumption, LOS, rescue analgesia requirements, and complication rates were comparable between groups (p > 0.05). CONCLUSION: PVB was associated with lower early postoperative pain scores and higher QoR-15 scores at 24 h compared with ESPB; however, the between-group difference in QoR-15 was below the minimal clinically important difference. Overall opioid consumption and clinical outcomes were comparable. Further multicenter studies are needed to determine whether these findings translate into clinically meaningful long-term benefits. TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT06558331). The clinical trial was prospectively registered on August 14, 2024.