ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1651245
The impact of ultrasound-guided erector spinae plane block combined with paravertebral block on postoperative rebound pain following thoracoscopic lobectomy
Provisionally accepted
- 1Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- 2Sichuan University West China Second University Hospital, Chengdu, China
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Here is a condensed version (under 350 words): Background:Thoracic paravertebral block (TPVB) is standard for pain after VATS but often causes rebound pain when it wears off. As the erector spinae plane block (ESPB) might reduce rebound pain by diffusing local anesthetic into the paravertebral space, this study investigated if combining TPVB with ESPB lowers rebound pain incidence. Methods:110 patients undergoing VATS lobectomy were randomized to TPVB alone (Group P, n=55) or TPVB+ESPB (Group PE, n=55). Group P received ultrasound-guided TPVB at T5 with 20 mL 0.5% ropivacaine. Group PE received TPVB with 10 mL ropivacaine followed by ESPB at the same level with 10 mL ropivacaine. The primary outcome was rebound pain incidence within 24 hours. Secondary outcomes included pain scores (NRS at rest/activity), time to rebound pain, Modified Rebound Pain Scale (MRPS), QoR-15 scores, 48-hour sufentanil consumption, rescue analgesia needs, hospital stay, satisfaction, and complications. Results: Group PE had a significantly lower incidence of rebound pain within 24 hours (23.64% vs 47.27%, P=0.010) and a lower MRPS score (3.06 ± 1.75 vs 3.84 ± 2.05, P=0.035) compared to Group P. Group PE also had significantly lower activity NRS scores on postoperative day 1 morning (D1 am), evening (D1 pm), and day 2 evening (D2 pm), as well as a lower resting NRS score on D1 am. Furthermore, Group PE demonstrated higher QoR-15 scores on days 1 and 2, reduced 48-hour sufentanil consumption (P=0.002), fewer rescue analgesia doses (P=0.048), and a shorter postoperative hospital stay (P<0.001). Conclusion: Combining TPVB with ESPB significantly reduces postoperative rebound pain incidence and severity, provides superior analgesia (especially during activity), improves recovery quality, decreases opioid requirements, and shortens hospital stay compared to TPVB alone after VATS.
Keywords: rebound pain, Paravertebral block, Erector spinae plane block, Thoracoscopic surgery, postoperative recovery quality
Received: 21 Jun 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 He, Chen, Zuo and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Youbo Zuo, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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