The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery

Abstract

Background This study aimed to determine whether ultrasound-guided continuous erector spinae plane block (ESPB) had an effect on opioid consumption and postoperative rehabilitation in patients undergoing video-assisted thoracic surgery (VATS). Methods In this prospective study, 120 patients aged 20–70 years who underwent elective VATS were randomly allocated to one of three groups: group C (general anesthesia with patient-controlled intravenous analgesia [PCIA]), group T (general anesthesia with patient-controlled epidural analgesia [PCEA]), or group E (general anesthesia with continuous ESPB and PCIA). Perioperative opioid consumption, visual analog scale (VAS) scores, preoperative and postoperative Quality of Recovery-15 scores, and postoperative opioid-related adverse events were all assessed. Results Intraoperative sufentanil consumption in groups T and E was significantly lower than that in group C (both P < 0.001), and the postoperative sufentanil consumption in group E was also significantly lower than that in group C (P = 0.001). Compared with group C, the VAS scores at rest or during coughing immediately out of the post-anesthesia care unit at 6 h, 12 h, and 24 h postoperatively were significantly lower in group T (P < 0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in group E were lower than those of group C (P < 0.05), but were significantly higher than those of group T at all study times (P < 0.05). Conclusion Ultrasound-guided continuous ESPB significantly reduced perioperative opioid consumption during VATS and improved postoperative rehabilitation. However, these effects were inferior to those of thoracic epidural anesthesia. Trial registration The present study was prospectively registered at http://www.chictr.org/cn /(registration number: ChiCTR1900023050); registration date: May 82,019.

Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial

“…An effective analgesic administration accelerates recovery, contributes to the early mobilization of patients, and reduces hospital stay [ 2 , 3 ]. Thoracic epidural analgesia (TEA) is the most commonly used and still accepted gold standard method in the treatment of post-thoracotomy pain [ 4 ]. However, serious complications such as dural puncture, sympathetic block, spinal hematoma, and epidural abscess can also be seen due to epidural application [ 5 ].…”

“…However, serious complications such as dural puncture, sympathetic block, spinal hematoma, and epidural abscess can also be seen due to epidural application [ 5 ]. Thoracic paravertebral block (TPVB) application has also been used in recent years due to the lower incidence of side effects such as hypotension, urinary retention, and nausea and vomiting compared to TEA [ 4 , 6 ]. With the widespread use of ultrasound (US) in recent years, different thoracic wall block techniques, which are claimed to cause fewer complications, have begun to be applied [ 7 ].…”

A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery

“…Our findings are consistent with the previous study that postoperative pain at rest and coughing in continuous ESP block were significantly higher than TEA 24 hours after surgery. 28 On the contrary, Nagaraja et al 10 have reported comparable pain scores in both TEA and ESP block groups in the early postoperative period after cardiac surgery and that an ESP block might be superior to TEA at 24 h, 36 h, and 48 h, both at rest and while coughing.…”

Thoracic Erector Spinae Plane Catheter as a Bridge to Patient-Controlled Thoracic Epidural Analgesia in Unilateral Lung Transplantation

“…When the placement of a thoracic epidural is not possible, ESP catheters can be utilized to manage postoperative pain after thoracotomy [6,11]. These can be done either unilaterally or bilaterally, depending on the surgery performed.…”

“…One case series of 42 patients demonstrated that when performed at the T5 level, the patients had decreased sensation in a dermatomal distribution from T3 to T10, with no significant adverse effects [6]. While several studies demonstrate ESP blocks' efficacy in minimizing opioids for various thoracic surgeries [6,11], there is very little in the literature about using ESP catheters in lung transplant patients.…”