Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study

Abstract

Introduction: The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). Methods: The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. Results: One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB −0.80 [−1.50; −0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [−2.65; −0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. Conclusions: Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB.

Loco-Regional Anesthesia for Pain Management in Robotic Thoracic Surgery

“…To date, evidence supporting the use of ESPB in robotic surgery is very limited and of low-moderate quality. A recent retrospective study by Durey et al [ 62 ] showed that ESPB is associated with less post-operative static and dynamic pain at 24 h than PVB after robot-assisted thoracic surgery for lung cancer, with a high safety profile. Moreover, a randomized controlled trial [ 63 ] on sixty adult patients undergoing minimally invasive thoracic surgery compared a single-shot ESPB to serratus anterior plane block before surgery on the quality of patient recovery at 24 h. In this study, ESPB provided superior quality of recovery, lower morbidity, and better analgesia after robotic surgery.…”

Beyond the Frontline: A Triple-Line Approach of Thoracic Surgeons in Lung Cancer Management—State of the Art

“…Results are debated concerning operative lymph node staging, and nodal upstaging in open surgery, VATS, or RATS [ 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. Thanks to advances in anesthesia [ 57 ] and surgery, the mortality rate of lung surgery has decreased over the years [ 58 , 59 ]. Today, the 30-day mortality rate has further decreased to 2% after open lobectomy, 1.3% after minimally invasive lobectomy, and less than 1% after segmentectomy [ 47 , 60 , 61 ].…”

“…These techniques can lead to smaller incisions, reduced tissue trauma, and faster recovery [ 3 ]. Additionally, optimized pain management strategies, such as the use of regional anesthesia or nerve blocks, are employed to minimize postoperative pain and facilitate early mobilization [ 57 ]. The postoperative phase of the ERAS program focuses on early recovery and rehabilitation.…”

Prolonged Effect of Repetitive Erector Spinae Plane Block in Reducing Thoracic Pain Caused by Lung Cancer

“…ESPB is commonly used for postoperative analgesia, particularly in patients undergoing thoracotomy for lung cancer. Nonetheless, existing studies assessing its postoperative analgesic effect have primarily focused on short-term efficacy [7]. Additionally, two cases of continuous ESPB for pain palliation in Pancoast tumors and pleural mesothelioma have been reported [8,9].…”