The following is a summary of “Association of Regional Block with Intraoperative Opioid Consumption in Patients Undergoing Video-Assisted Thoracoscopic Surgery: a single-center, Retrospective Study,” published in the March 2024 issue of Surgery by Xiang et al.
Regional blocks, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), or serratus anterior plane block (SAPB), have emerged as promising strategies for mitigating postoperative opioid consumption, as endorsed by recent guidelines. However, determining the optimal approach for minimizing intraoperative opioid usage remains a subject of ongoing investigation. This retrospective study aimed to assess the efficacy of three distinct regional blocks (TEA, TPVB, and SAPB) in reducing intraoperative opioid requirements among patients undergoing video-assisted thoracoscopic surgery (VATS).
The study encompassed a retrospective analysis of adult patients undergoing VATS procedures at a tertiary medical center between January 2020 and February 2022. Patients were categorized into four groups based on the type of regional block administered: general anesthesia alone (GA group), general anesthesia combined with TEA (TEA group), TPVB (TPVB group), or SAPB (SAPB group). Matching was performed at a 1:1:1:1 ratio for age, sex, ASA physical status, and duration of the operation to ensure comparability across groups. The primary outcome measure was the total intraoperative opioid consumption, standardized to Oral Morphine Equivalents (OME).
Multivariable linear regression analysis was employed to assess the association between the various regional blocks and OME.
Among the 2,159 eligible cases identified, 168 were included for analysis following matching (42 in each group). Comparative analysis revealed that compared to GA without any regional block, the utilization of TEA and TPVB corresponded to substantial reductions in median intraoperative OME by 78.45 mg (95% CI, -141.34 to -15.56; P = 0.014) and 94.92 mg (95% CI, -154.48 to -35.36; P = 0.020), respectively. However, the impact of SAPB on intraoperative opioid consumption remained inconclusive, with a marginal reduction of 11.47 mg (95% CI, -72.07 to 49.14; P = 0.711).
In conclusion, their findings underscore the potential of TEA and TPVB to significantly attenuate intraoperative opioid requirements in adults undergoing VATS procedures. Nevertheless, further investigation is warranted to elucidate the precise role of SAPB in this context.
Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-02611-3