比较接受硬膜外镇痛或椎旁镇痛进行微创食管切除术 (MIE) 的患者的恢复质量。椎旁镇痛可能是硬膜外镇痛的一种有前途的替代方案，可避免潜在的副作用并改善术后恢复。这项随机对照优效性试验在四个荷兰人中进行食管癌患者中心计划进行经胸 MIE 胸内吻合术，随机将患者接受硬膜外镇痛或椎旁镇痛。主要结局是术后第三天（POD）的恢复质量（QoR-40）。次要结局包括生活质量、术后疼痛、阿片类药物消耗、正性肌力药物/升压药物使用、住院时间、并发症、再入院和死亡率。从 2019 年 12 月至 2023 年 2 月，纳入了 192 名患者：94 名患者接受硬膜外镇痛，98 名患者接受椎旁镇痛。 POD3 的 QoR-40 评分在组间没有差异（平均差 3.7，95%CI -2.3 至 9.7；P=0.268）。硬膜外患者在 POD1 和 2 上的 QoR-40 评分显着较高（平均差 7.7，95%CI 2.3-13.1；P=0.018，平均差 7.3，95%CI 1.9-12.7；P=0.020）和较低的疼痛评分（中位数） 1 与 2；P=<0.001，中位数 1 与 2；P=0.033）。更多硬膜外患者在 POD1 时需要血管加压药物（38.3% 对比 13.3%；P<0.001）。椎旁组较早拔除导尿管（中位 POD3 对比 4；P=<0.001）。在术后并发症或住院/重症监护病房停留方面没有发现显着差异。这项随机对照试验并未证明椎旁镇痛相对于硬膜外镇痛在 MIE 后 POD3 恢复质量方面的优越性。这两种技术都很有效，并且可以应用于临床实践。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality.From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay.This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.