Skip to main content

Advertisement

SpringerLink
Log in

Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of ultrasonography (USG) guided continuous erector spinae plane block (ESPB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS).

Methods

Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged 18–75 and who were to undergo VATS were included in this study. Randomization was performed in 2 groups, continuous ESPB (ESPB Group) and no intervention (Control Group). 20 mL of 0.25% bupivacaine was administered for the block. Immediately after surgery, the patient received continuous infusion of 0.125% bupivacaine at 4 mL h−1 via the catheter inserted for the block. Patients in both groups received tramadol via an intravenous patient-controlled analgesia device. Tramadol and meperidine consumption, visual analog scale pain scores and opioid-related side effects were recorded at 0, 1, 4, 8, 12, 24, 36, and 48 h postoperatively.

Results

The use of continuous ESPB in VATS significantly decreased the amount of tramadol used in the first 48 h postoperatively (P < 0.001). There was a statistically significant difference in the number of meperidine rescue analgesia administered between the ESPB and Control Groups (P < 0.001). While the incidences of nausea and itching were higher in Control Group, there were no differences in terms of the other side effects between the groups.

Conclusions

This study shows that USG-guided continuous ESPB provides adequate analgesia following VATS as part of multimodal analgesia. Continuous ESPB significantly reduced opioid consumption and opioid-related side effects compared to those in the Control Group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Piccioni F, Segat M, Falini S, Umari M, Putina O, Cavaliere L, et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. J Thorac Dis. 2018;10(4):555–63. https://doi.org/10.21037/jtd.2017.12.86.

    Article  Google Scholar 

  2. Bulgarelli Maqueda L, García-Pérez A, Minasyan A, Gonzalez-Rivas D. Uniportal VATS for non-small cell lung cancer. Gen Thorac Cardiovasc Surg. 2020;68(7):707–15. https://doi.org/10.1007/s11748-019-01221-4.

    Article  PubMed  Google Scholar 

  3. Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Kehlet H. Persistent postsurgical pain after video-assisted thoracic surgery—an observational study. Acta Anaesthesiol Scand. 2016;60(5):650–8. https://doi.org/10.1111/aas.12681.

    Article  CAS  PubMed  Google Scholar 

  4. Khoshbin E, Al-Jilaihawi AN, Scott NB, Prakash D, Kirk AJ. An audit of pain control pathways following video-assisted thoracoscopic surgery. Innovations (Phila). 2011;6(4):248–52. https://doi.org/10.1097/IMI.0b013e31822b2cc1.

    Article  Google Scholar 

  5. Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg. 2014;45(6):959–66. https://doi.org/10.1093/ejcts/ezt525.

    Article  PubMed  Google Scholar 

  6. Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018;21(3):323–7. https://doi.org/10.4103/aca.ACA_16_18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Holbek BL, Horsleben Petersen R, Kehlet H, Hansen HJ. Fast-track video-assisted thoracoscopic surgery: future challenges. Scand Cardiovasc J. 2016;50(2):78–82. https://doi.org/10.3109/14017431.2015.1114665.

    Article  PubMed  Google Scholar 

  8. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7. https://doi.org/10.1097/AAP.0000000000000451.

    Article  CAS  PubMed  Google Scholar 

  9. Aksu C, Gurkan Y. Ultrasound-guided bilateral erector spinae plane block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients. Anaesth Crit Care Pain Med. 2019;38(1):87–8. https://doi.org/10.1016/j.accpm.2018.03.008.

    Article  PubMed  Google Scholar 

  10. Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia. 2021;76(3):404–13. https://doi.org/10.1111/anae.15164.

    Article  CAS  PubMed  Google Scholar 

  11. Ciftci B, Ekinci M, Celik EC, Tukac IC, Bayrak Y, Atalay YO. Efficacy of an ultrasound-guided erector spinae plane block for postoperative analgesia management after video-assisted thoracic surgery: a prospective randomized study. J Cardiothorac Vasc Anesth. 2020;34(2):444–9. https://doi.org/10.1053/j.jvca.2019.04.026.

    Article  PubMed  Google Scholar 

  12. Gurkan Y, Aksu C, Kus A, Yorukoglu UH, Kilic CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: a randomized controlled study. J Clin Anesth. 2018;50:65–8. https://doi.org/10.1016/j.jclinane.2018.06.033.

    Article  PubMed  Google Scholar 

  13. Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20(2):187–91. https://doi.org/10.1016/j.jcrc.2005.04.005.

    Article  PubMed  Google Scholar 

  14. Umari M, Carpanese V, Moro V, Baldo G, Addesa S, Lena E, et al. Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg. 2018;53(5):932–8. https://doi.org/10.1093/ejcts/ezx413.

    Article  PubMed  Google Scholar 

  15. Lonnqvist P, Karmakar MK, Richardson J, Moriggl B. Daring discourse: should the ESP block be renamed RIP II block? Reg Anesth Pain Med. 2021;46(1):57–60. https://doi.org/10.1136/rapm-2020-101822.

    Article  CAS  PubMed  Google Scholar 

  16. Ueshima H, Hiroshi O. Erector spinae plane block for carotid endarterectomy. J Clin Anesth. 2018;48:11. https://doi.org/10.1016/j.jclinane.2018.04.004.

    Article  PubMed  Google Scholar 

  17. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018;43(7):756–62. https://doi.org/10.1097/AAP.0000000000000798.

    Article  PubMed  Google Scholar 

  18. Cai Q, Liu GQ, Huang LS, Yang ZX, Gao ML, Jing R, et al. Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: a systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2020;80:107–16. https://doi.org/10.1016/j.ijsu.2020.05.038.

    Article  PubMed  Google Scholar 

  19. Tsui BCH, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: a pooled review of 242 cases. J Clin Anesth. 2019;53:29–34. https://doi.org/10.1016/j.jclinane.2018.09.036.

    Article  PubMed  Google Scholar 

  20. Tulgar S, Aydin ME, Ahiskalioglu A, De Cassai A, Gurkan Y. Anesthetic techniques: focus on lumbar erector spinae plane block. Local Reg Anesth. 2020;2020(13):121–33. https://doi.org/10.2147/LRA.S233274.eCollection.

    Article  Google Scholar 

  21. Aksu C, Gurkan Y. Opioid sparing effect of erector spinae plane block for pediatric bilateral inguinal hernia surgeries. J Clin Anesth. 2018;50:62–3. https://doi.org/10.1016/j.jclinane.2018.06.048.

    Article  PubMed  Google Scholar 

  22. Liu SS, Salinas FV. Continuous plexus and peripheral nerve blocks for postoperative analgesia. Anesth Analg. 2003;96(1):263–72. https://doi.org/10.1097/00000539-200301000-00053.

    Article  PubMed  Google Scholar 

  23. Leyva FM, Mendiola WE, Bonilla AJ, Cubillos J, Moreno DA, Chin KJ. Continuous erector spinae plane (ESP) block for postoperative analgesia after minimally invasive mitral valve surgery. J Cardiothorac Vasc Anesth. 2018;32(5):2271–4. https://doi.org/10.1053/j.jvca.2017.12.020.

    Article  PubMed  Google Scholar 

  24. Nath S, Bhoi D, Mohan VK, Talawar P. USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: a report of two cases. Saudi J Anaesth. 2018;12(3):471–4. https://doi.org/10.4103/sja.SJA_755_17.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gao Z, Xiao Y, Wang Q, Li Y. Comparison of dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial. Ann Transl Med. 2019;7(22):668. https://doi.org/10.21037/atm.2019.10.74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shim JG, Ryu KH, Kim PO, Cho EA, Ahn JH, Yeon JE, et al. Evaluation of ultrasound-guided erector spinae plane block for postoperative management of video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial. J Thorac Dis. 2020;12(8):4174–82. https://doi.org/10.21037/jtd-20-689.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Scimia P, Basso Ricci E, Droghetti A, Fusco P. The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy. Reg Anesth Pain Med. 2017;42(4):537. https://doi.org/10.1097/AAP.0000000000000616.

    Article  PubMed  Google Scholar 

  28. Yayik AM, Ahiskalioglu A, Celik EC, Ay A, Ozenoglu A. Continuous erector spinae plane block for postoperative analgesia of multiple rib fracture surgery: case report. Rev Bras Anestesiol. 2019;69(1):91–4. https://doi.org/10.1016/j.bjan.2018.08.001.

    Article  Google Scholar 

  29. Baytar MS, Yılmaz C, Karasu D, Baytar Ç. Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study. Korean J Pain. 2021;34(2):234–40. https://doi.org/10.3344/kjp.2021.34.2.234.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Horn A, Kaneshiro K, Tsui BCH. Preemptive and preventive pain psychoeducation and its potential application as a multimodal perioperative pain control option: a systematic review. Anesth Analg. 2020;130(3):559–73. https://doi.org/10.1213/ANE.0000000000004319.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We want thank Dr. Alkım Gizem Yılmaz for their kind assistance with the study.

Funding

No funding to declare.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey

    Özcan Pişkin, Çağdaş Baytar, Bengü Gülhan Aydın, Rahşan Dilek Okyay, Gamze Küçükosman, Keziban Bollucuoğlu & Hilal Ayoğlu

  2. Department of Thoracic Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey

    Mertol Gökçe

  3. Department of Pulmonary Medicine, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey

    Bülent Altınsoy

Authors
  1. Özcan Pişkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mertol Gökçe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bülent Altınsoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Çağdaş Baytar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bengü Gülhan Aydın
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rahşan Dilek Okyay
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gamze Küçükosman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Keziban Bollucuoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hilal Ayoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Özcan Pişkin.

Ethics declarations

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (AVI 711 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pişkin, Ö., Gökçe, M., Altınsoy, B. et al. Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study. Gen Thorac Cardiovasc Surg 70, 64–71 (2022). https://doi.org/10.1007/s11748-021-01687-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-021-01687-1

Keywords

Search

Navigation