The trade-off between analgesic potency and procedural safety: Erector spinae plane block versus the gold-standard thoracic paravertebral block in uniportal and multiportal video-assisted thoracoscopic surgery — a systematic review and meta-analysis of randomized controlled trials and primary studies

Introduction

Uniportal and multiportal video-assisted thoracoscopic surgery (VATS) reduce surgical trauma, yet moderate-to-severe acute pain remains common and predisposes to pulmonary complications and chronic postsurgical pain (CPSP). The thoracic paravertebral block (TPVB) is regarded as the regional "gold standard", whereas the erector spinae plane block (ESPB) is technically simpler and theoretically safer. Whether ESPB trades analgesic potency for procedural safety has not been quantified jointly. We aimed to compare the analgesic efficacy, opioid-sparing effect, recovery quality and procedural safety of ESPB versus TPVB, hypothesising that TPVB provides superior early analgesia, that both blocks converge beyond the early period, and that ESPB carries fewer block-related complications.