Ultrasound-guided erector spinae block for postoperative analgesia in thoracotomy patients: a prospective, randomized, observer-blind, controlled clinical trial

Abstract

Background and objectives Thoracotomy is considered the most painful of surgical procedures and providing adequate analgesia is the onus for all anaesthesiologists. This study investigated the efficacy of the ultrasound-guided erector spinae plane (ESP) block in analgesia after thoracotomies. Patients and methods Sixty patients with American Society of Anesthesiology physical status (ASA-PS) I–IV, aged more than 18 years were allocated to two groups, ESP group which received the ESP block and C (control) group with no block. Single-shot U/S-guided ESP block with 20 ml 0.25% bupivacaine at the 5th thoracic vertebral level was performed preoperatively in the ESP group. Postoperative 24 h morphine consumption and pain scores were compared between the groups. Also, the side effects of opioid usage were compared. Main results Postoperative morphine consumption was 22.06 ± 6.24 mg in the ESP group and 30.6 ± 6.23 mg in the C group (p < 0.001). Results showed that there was a significant difference between both groups in favour of the ESP group regarding visual analogue score (VAS) at rest and with coughing (p < 0.001). Conclusion Our study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing thoracotomy surgery. Trial registration ClinicalTrials.gov, NCT03749395. Registered 13 November 2018

Comparison of Postoperative Opioid Consumption of Paravertebral Block and Erector Spinae Plane Block After Thoracotomy: A Randomized Controlled Trial

“…Thoracic surgical techniques are now preferred over other types of surgeries due to the ability of ESPB to provide effective postoperative analgesia. In thoracotomy surgery, Sobhy et al [14] compared ESPB with intravenous PCA. They showed that ESPB provided more effective analgesia.…”

Efficacy of ultrasound-guided erector spinae plane block versus retrolaminar block for postoperative analgesia in patients undergoing thoracotomy

“…In addition, the study revealed that the active and passive visual analog scores (VAS) during 24 hours were statistically lower in the ESPB group at all times of measurements when compared with the control group. In addition, Sobhy et al, [12] found that postoperative morphine consumption, pain scores at rest and during ~ 103 ~ coughing, morphine-related side effects, and hospital stay. 60 patients were allocated equally into two groups: ESPB (study) group and control group.…”

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

“…Literature Findings. Patients undergoing VATS [210][211][212] or thoracotomy 213 who received single-shot 210,211,213 erector spinae plane block (ESPB) reported superior pain control 210,212 and/or lower cumulative analgesic requirements 210,213 for 6 to 48 hours along with enhanced recovery 211 (Category A2-B evidence). [210][211][212][213] ESPB also facilitated spontaneously ventilating VATS surgery (Category B3 evidence).…”

“…Patients undergoing VATS [210][211][212] or thoracotomy 213 who received single-shot 210,211,213 erector spinae plane block (ESPB) reported superior pain control 210,212 and/or lower cumulative analgesic requirements 210,213 for 6 to 48 hours along with enhanced recovery 211 (Category A2-B evidence). [210][211][212][213] ESPB also facilitated spontaneously ventilating VATS surgery (Category B3 evidence). 214,215 The addition of nalbuphine 216 or dexmedetomidine 216,217 alone or in combination with dexamethasone 218 to the LA mixture for ESPB may enhance analgesia and prolong the duration of the block 219 (Category A2-B evidence 216,217,219 /Category A3-E evidence 218 ).…”