Discussion
postoperative pain, ESPB, Postoperative pain, chronic postoperative pain, pain
CHRONIC POSTOPERATIVE PAIN, INFILTRATION
The current study demonstrates that both RIB and SAPB were effective techniques in providing analgesia for patients undergoing VATS. RIB and SAPB were performed before the skin incision, "preemptive analgesia," to induce better analgesia compared to blocks performed after surgery owing to its protective effect on the human nociceptive system [Both block techniques were effective in pain control after the procedure, and the analgesic profile was much better in RIB (rejecting our null hypothesis). That could be explained by the extent of the block in both techniques. RIB covers the entire hemithorax anteriorly and posteriorly, while SAPB covers the anterolateral chest wall region as it mainly affects the lateral intercostal nerve branches and omits the posterior main sensory branch [Our finding correlate with those of Zhang et al., who conducted a prospective trial comparing RIB, SAPB, and erector spinae plane block (ESPB) in patients undergoing VATS. Postoperative pain scores, the time to first analgesic request, and opioid consumption were comparable between RIB and ESPB and more superior to SAPB [Similar results have been reported in a retrospective study compared RIB to SAPB in VATS procedures and found that pain scores were significantly reduced with RIB. Nonetheless, opioid consumption was statistically comparable between the two block techniques (122 mg vs. 151 mg in Groups R and S, respectively – RIB was initially described by Elsharkawy and his associates. The local anesthetic agent is administered into the fascial plane between the rhomboid and intercostal muscles, providing analgesia for the region supplied by T 2–9 dermatomes in both anterior and posterior chest walls by targeting the lateral cutaneous branches of the ventral thoracic nerves. The spread of the local anesthetic in both craniocaudal and anteroposterior directions could explain its wide coverage, even when the injectate is administered into a single level [SAPB was first described by Blanco and his associates for pain management after chest and breast operations [As regard RIB, our finding was in agreement with Deng et al., who evaluated RIB for elective unilateral VATS. The total amount of sufentanil in 24 h after the surgery in the RIB group was less than those in the control group at (Similar results have been reported by Altıparmak et al., who demonstrated that RIB was associated with a significant improvement in patient recovery (recovery score 164.8 vs. 153.5 in controls – As regard SAPB, our findings correlate with those of Park et al., who evaluated SAPB on postoperative pain and opioid consumption after thoracoscopic surgery. SAPB reduced the worst median (IQR [range]) pain score 6 (5–7 [Moreover, Chen and his associates evaluated the effects of SAPB on postoperative pain after thoracoscopic surgery compared with local anesthetic (LA) infiltration. Postoperative sufentanil consumption in the SAPB group was significantly lower compared with the LA group (There are limitations of our study as the patients were collected from a single medical center, both block techniques were performed as a single shot, and its effect on chronic postoperative pain was not evaluated. That is why we recommend performing more studies with a larger patient sample.