Effects of Ropivacaine-Based Thoracic Paravertebral Block versus Erector Spinae Plane Block on Quality of Recovery in Laparoscopic Colorectal Cancer Surgery: A Randomized Controlled Trial

Background: Colorectal cancer remains a leading cause of cancer-related mortality worldwide. Postoperative pain can impair recovery. Thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) are regional analgesic techniques that may enhance recovery, but their comparative efficacy in colorectal surgery is not well established. This study aimed to compare the effects of TPVB and ESPB on the quality of recovery in patients undergoing colorectal cancer surgery. Methods: In this single-center, single-blind, randomized controlled trial, 87 patients scheduled for elective laparoscopic colorectal cancer surgery were initially enrolled and randomly assigned. Ultimately, 85 patients were included in the per-protocol analysis, distributed as follows: the bilateral TPVB (n = 29), the bilateral ESPB (n = 28), and the control (n = 28). Both blocks were performed at the T10 level using 20 mL of 0.375% ropivacaine per side. The primary outcome was the Quality of Recovery-15 (QoR-15) scores at 24 hours postoperatively. Secondary outcomes included pain scores, overall benefit of analgesia scores (OBAS), area under the curve (AUC) analyses for these scores and opioid consumption. Results: Both TPVB and ESPB groups had higher QoR-15 scores at 24 hours compared to controls (TPVB: 122.03 ± 4.00, ESPB: 119.00 ± 3.09, Control: 109.79 ± 2.89; both P < 0.001). TPVB provided a statistically significant, yet clinically modest, improvement in recovery over ESPB at 24 hours (mean difference [MD] 3.03; 95% CI, 0.09 to 5.98; P = 0.036). However, QoR‑15 AUC over 72 hours did not differ between blocks ( P = 0.12). Both blocks resulted in better OBAS throughout the first 48 hours (all P < 0.05). TPVB also demonstrated better early resting pain control at 6 hours ( P = 0.012) but had a longer performance time than ESPB ( P = 0.003). Both intervention groups reduced opioid consumption. Conclusion: Both TPVB and ESPB improve recovery quality and analgesia after laparoscopic colorectal cancer surgery. Overall, the two block techniques provided comparable benefits for postoperative recovery and analgesia. Trial Registration: ChiCTR2400089500. Keywords: erector spinae plane block, paravertebral block, quality of recovery, enhanced recovery after surgery, colorectal cancer