Ultrasound Guided Erector Spinae Plane Block; an Alternative to Epidural Analgesia for Pain Management After Thoracotomy

Abstract

Background: Severe postoperative pain may occur following thoracotomy. The sources of this pain often include multiple muscle incisions, chest drains and possible rib injury. The management of this pain is extremely important for rehabilitation in the postoperative period. Thoracic epidural analgesia (TEA) represents the "gold standard" of pain control. However, this approach has serious problems such as hypotension, urinary retention, and hematoma. The erector spinae plane block (ESPB) is a novel regional analgesia technique and it is a simple, safe and effective method that can be applied as an alternative. The aim of this study was to assess the analgesic effectiveness of the ESPB and TEA techniques after thoracotomy. Materials and Methods:This retrospective, single-center study conducted between October 2018 and September 2020. We evaluated 83 patients who received ESPB, TEA and conventional (non-regional) technique. Demographic data, operation type and duration, postoperative visual analog scale (VAS) scores, opioid consumption were obtained from anesthesia and clinical patient follow-up forms. Results:The study included 83 patients who underwent thoracotomy and were divided into three groups as group ESPB (28), group TEA (33) and group control (22) who did not apply any regional analgesia method. The VAS scores at the 8 th , 24 th and 48 th hours postoperatively, were found to be significantly lower in the ESPB and TEA groups compared to the control group (p<0.05). ESPB and TEA groups had similar levels of VAS scores and opioid consumption (p>0.05). Opioid consumptions of ESPB and TEA groups was significantly lower than that in the control group (p<0.05). Conclusion:ESPB, which provides a similar level of analgesia with TEA in the management of postoperative analgesia in thoracotomy, can be considered a good alternative regional analgesia technique especially in patients with additional comorbidities such as obesity and spinal deformity.