Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery

Kukreja, Promil; Herberg, Timothy J; Johnson, Brittany M.; Kofskey, Alexander M; Short, Roland T.; MacBeth, Lisa; Paul, Christopher; Kalagara, Hari

doi:10.7759/cureus.18533

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…Pain control after thoracic surgery is crucial owing to the fact that adequate postoperative analgesia prevents serious postoperative complications, such as pneumonia and respiratory failure [9]. Paravertebral blocks, as an anaesthetic intervention to reduce postoperative pain in thoracic surgery patients, are used to achieve analgesic benefit in wide-ranging surgical procedures [10]. Erector spinae plane block is a relatively new method of paraspinal fascial plane block proposed by Forero in 2016.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study

He,

Zhang,

Wei

2024

HSF

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Objective: This study aimed to compare the value of thoracic paravertebral block and ultrasound-guided erector spinal muscle plane block in video-assisted analgesia after thoracic surgery. Methods: Patients undergoing video-assisted thoracic surgery at our hospital from March 2022 to May 2023 were included as the subjects of this retrospective study. According to different analgesia methods, they were divided into an ultrasound group (acoustic-guided erector spinae plane block) and a conventional group (thoracic paravertebral block). General demographic data, sufentanil dose, propofol dose, blood loss and fluid replacement volume, puncture depth and time, length of stay, complications, number of analgesic pump compression, forced vital capacity (FVC), 1 s forced expiratory volume (FEV1), peak expiratory flow rate (PEFR), visual simulation (VAS) score, and 15 recovery quality evaluation components were collected Table (QoR-15). Propensity score matching (PSM) was used to balance the baseline data of the two groups. Data were analyzed by t test, chi-square test, and analysis of variance. Results: A total of 116 patients were included in this study, including 52 in the ultrasound group and 64 in the conventional group. Before PSM, statistically significant differences in age, weight, lesion location, and surgical methodmethod existed among the groups (p < 0.05). PSM matching was performed in a 1:1 ratio, and a total of 82 patients were enrolled in the ultrasound and conventional groups. The baseline data of the two groups were not statistically significant. The complications, hospital stay, pressing times of analgesic pump, and puncture depth and time in the ultrasound group were lower than those in the conventional group (p < 0.05). Two groups of tube drawing when resting and cough VAS difference (p > 0.05), but after 12, 24, and 48 h, ultrasonic VAS scores were lower than those of the normal group (p < 0.05). When two groups of T1 lung function difference (p > 0.05), but the T2, T3 FVC, FEV1, and PEFR ultrasound group were higher than those of the conventional group (p < 0.05). No significant difference in preoperative QoR-15 score existed between the two groups (p > 0.05), but the postoperative QoR-15 score in the ultrasound group was higher than that in the conventional group (p < 0.05). Conclusions: Ultrasound-guided erector spinae plane block had stronger analgesic effect, which can reduce the pressing times of analgesic pump, quickly reduce pain, and improve lung function with fewer complications. Thus, it can significantly improve the quality of postoperative recovery and reduce the length of hospital stay, rendering its application worthy of promotion.

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Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study

He,

Zhang,

Wei

2024

HSF

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“…With the advent of ultrasound, never regional techniques depending on fascial planes have begun to supplement and, in some cases replace the TEA as the standard analgesic technique for patients undergoing thoracic surgery. Initial retrospective studies suggest potential noninferiority of fascial plane blocks to TEA ( 47 ). However, this study included video-assisted thoracoscopic surgery (VATS) or thoracotomy for wedge resection, lobectomy, esophagectomy, or pectus repair causing varying levels of postoperative pain.…”

Section: Epidural Blockmentioning

confidence: 99%

Regional anesthesia for thoracic surgery: a narrative review of indications and clinical considerations

Sertçakacılar¹,

Tire²,

Kelava³

et al. 2022

J Thorac Dis

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Background and Objective: Surgical procedures involving incisions of the chest wall regularly pose challenges for intra-and postoperative analgesia. For many decades, opioids have been widely administered to target both, acute and subsequent chronic incisional pain. Opioids are potent and highly addictive drugs that can provide sufficient pain relief, but simultaneously cause unwanted effects ranging from nausea, vomiting and constipation to respiratory depression, sedation and even death. Multimodal analgesia consists of the administration of two or more medications or analgesia techniques that act by different mechanisms for providing analgesia. Thus, multimodal analgesia aims to improve pain relief while reducing opioid requirements and opioid-related side effects. Regional anesthesia techniques are an important component of this approach.Methods: For this narrative review, authors summarized currently used regional anesthesia techniques and performed an extensive literature search to summarize specific current evidence. For this, related articles from January 1985 to March 2022 were taken from PubMed, Web of Science, Embase and Cochrane Library databases. Terms such as "pectoral nerve blocks", "serratus plane block", "erector spinae plane block" belonging to blocks used in thoracic surgery were searched in different combinations.

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“…Depending on the height of the block and the concentration of the local anaesthetic drug, the duration of the block can be controlled. The catheter failure rate is 16% in the thoracic epidural space [10]. A second popular method is to use a bilateral erector spinae plane (ESP) block and deposit the local anaesthetic drug in the intercostal space between the dorsal extensor muscle and the intercostal muscles [9].…”

Section: Introductionmentioning

confidence: 99%

“…A second popular method is to use a bilateral erector spinae plane (ESP) block and deposit the local anaesthetic drug in the intercostal space between the dorsal extensor muscle and the intercostal muscles [9]. Due to anatomical reasons (the thickness of muscle's epimysium and the size of needle's outer diameter), the precise injection of fascial plane blocks could be a challenge [10]. Moreover, improper administration of a fascial plane block may cause myotoxicity due to the local anaesthetic.…”

Section: Introductionmentioning

confidence: 99%

Benefits of the Erector Spinae Plane Block before Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity

Zacha,

Jarosz,

Kokot

et al. 2023

JPM

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Thoracic surgery causes significant pain despite standard multimodal analgesia. Intraoperative cryoanalgesia may be a solution. The onset of the clinical effect of cryoanalgesia can take 12–36 h. The addition of a regional anaesthesia before the cryoanalgesia procedure can enable analgesic protection for the patient during this period. The main aim of the study was to evaluate the benefits of the erector spinae plane (ESP) block prior to Nuss surgery. The ‘control’ group consisted of 10 teenagers who underwent cryoablation together with intravenous multimodal analgesia according to the standard protocol. The ‘intervention’ group included 26 teenage patients who additionally received an erector spinae plane block before operation. Pain relief (p = 0.015), opioid use (p = 0.009), independent physical activity and rehabilitation (p = 0.020) were faster in the intervention group. No features of local anaesthetic drug toxicity or complications of the ESP block were observed. The bilateral ESP block together with intraoperative intercostal nerve cryoablation performed prior to Nuss correction of funnel chest were more effective in terms of pain control.

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Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery

Cited by 5 publications

References 24 publications

Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study

Comparison of Thoracic Paravertebral Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia after Video-Assisted Thoracic Surgery: A Retrospective Study

Regional anesthesia for thoracic surgery: a narrative review of indications and clinical considerations

Benefits of the Erector Spinae Plane Block before Cryoanalgesia in Children Undergoing Surgery for Funnel Chest Deformity

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