Rhomboid Intercostal Block Versus Retrolaminar Plane Block for Postoperative Analgesia in Patients Undergoing Video Assisted Thoracic Surgery. - NCT07928544

Retrolaminar block (RLB)(a modified form of paravertebral block (PVB) and The ultrasound-guided rhomboid intercostal block (UG-RIB) used to alleviate the postoperative pain in video assisted thoracic surgery (VATS). We hypothesized that RLB may offer superior analgesic coverage and efficacy compared to The ultrasound-guided rhomboid intercostal block (UG-RIB) in the context of VATS. 1\. INTRODUCTION/ REVIEW (Maximum 1000 words) "References are needed" Thoracic surgery is specialized in the study of the chest organs and mainly refers to the lung, esophagus, and mediastinum diseases diagnosis and treatment, such as chest trauma, lung tumors, esophageal tumors, chronic obstructive emphysema, tuberculosis, esophageal functional diseases, diaphragmatic diseases, and congenital diseases of the chest. So many patients need to be treated with thoracic surgery in the world. Compared to thoracotomy, video-assisted thoracic surgery (VATS) has similar therapeutic effects with less invasion and relieves postoperative pain significantly, promoting rehabilitation \[1-3\]. However, the VATS still causes moderate to severe postoperative pain \[4, 5\]. Postoperative analgesia is a critical issue in accelerating the rehabilitation of patients during the perioperative period. The thoracic epidural block (TEB) is the gold standard for analgesia for thoracic surgery. However, the complications such as hypotension and nerve injury caused by it have been a problem that cannot be ignored.(6) RLB is a modified form of paravertebral block (PVB) \[7\]. While PVB is increasingly used for chest and abdominal surgeries due to its precise analgesic effects, it carries a risk of serious complications, including pneumothorax, hypotension, or nerve damage \[8,9\]. Even with ultrasound guidance, performing a traditional PVB remains technically challenging, with its success heavily reliant on the operator's expertise. RLB, as an improved alternative to PVB, has received growing attention in recent years. It involves the ultrasound-guided injection of local anesthetic between the lamina of the thoracic vertebra and the erector spinal muscle \[10\]. Compared to PVB, RLB is easier to perform, associated with fewer complications such as pneumothorax, intrathecal injection, or vascular damage. However, the spread of anesthetic in RLB appears highly variable and is dose-dependent \[11,12\]. The ultrasound-guided rhomboid intercostal block (UG-RIB) was discovered by Elsharkawy et al. in 2016 \[13\]. It has been reported that UG-RIB can ensure adequate analgesia in modified radical mastectomy and VATS \[14, 15\]. However, a comparison of the analgesic efficacy between RIB and retrolaminar (RLB)has yet to be reported. Therefore, it is urgent to compare the clinical effects of RIB and RLB in alleviating acute pain following video-assisted thoracic surgery to provide a scientific and practical theoretical foundation for selecting a subsequent analgesic strategy. It is of great significance to improve patients' life and rehabilitation and avoid other complications after the operation.