Transversus Thoracic Muscle Plane Block, Erector Spinae Plane Block and Paravertebral Block for Analgesia in Video-Assisted Thoracic Surgery

Traditionally, resection is done via a thoracotomy. Still, video-assisted thoracoscopic surgery (VATS) provides significant advantages over open thoracotomy procedures, including reduced surgical pain, improved postoperative pulmonary function, reduced mortality, shortened hospital stay. It has emerged as a minimally invasive alternative.

Thoracic paravertebral block (TPVB) is a regional anesthetic technique in which local anesthetic (LA) is administered inside the thoracic paravertebral space (TPVS), which contains the intercostal spinal nerves, spinal dorsal rami, rami communicants, sympathetic chain, intercostal vessels, and fatty tissue.

The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach.

Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.

Inclusion criteria

• Age ≥ 18 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I-II.
• Scheduled for video-assisted thoracic surgery under general anesthesia.

Exclusion criteria

• Body mass index >30 kg/m2.
• Coagulopathy.
• History of opiate abuse.
• Pre-existing chronic pain.
• Allergy to local anesthetics or analgesics.
• Infection at the site of injection.
• Mental or neurological disorders.
• Operation converted to open thoracotomy.
• Renal dysfunction (glomerular filtration rate (GFR) < 50 ml/min).
• Pregnancy