The Efficacy of Ultrasound-guided Single Shot Erector Spinae Plane Block in Post-operative Pain Management after Thoracic Surgery in the First 48 Hours: A Prospective Descriptive Study

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Areerat Kaewanuchit


Background: Postoperative pain management after thoracic surgery is essential and can lead to serious postoperative complications if not appropriately managed. Ultrasound-guided thoracic erector spinae plane block (US-ESP block) has gained more popularity for postoperative pain management in thoracic surgery. However, there was no data on postoperative opioid consumptions and pain scores in Thailand. Objectives: The main objective of this study was to study the efficacy of single shot ultrasound-guided erector spinae plane block for postoperative pain management after thoracic surgery Methods:A prospective descriptive study was conducted in patients who underwent elective thoracic surgery at Central Chest Institute of Thailand with operative time of one hour or more during August 1 to December 30, 2020. The ultrasound-guided ESP at the level of the 5th thoracic vertebra was performed at the end of surgery with 1% xylocaine and 0.25% bupivacaine with adrenaline 10 and 20 mL, respectively. The efficacy of ESP was evaluated by 1) pain scores at 15, 30 minutes and 1, 2, 4, 8, 16, 24, and 48 hours postoperatively 2) time to first dose of postoperative morphine requirement 3) morphine consumption at 24 and 48 hours postoperatively. Results: Sixty two patients were included in the study. Thirty five cases (56.5%) were video-assisted thoracoscopic surgery (VATS). The mean duration of surgery was 170.5 minutes (ranges from 123.75-197.5 min). Thirty-nine (62.9%) patients did not receive any morphine at the recovery room. There were no patients who experienced severe pain in 48 hours postoperatively. Most of patients received first dose of morphine at 8 hours after the operation. The average of pain score at the first morphine requirement was 5. The average 24 and 48 hours postoperative morphine consumption was 7 and 7.19 mg respectively. Conclusion: The combination of the thoracic erector spinae plane block at the 5th thoracic level after thoracic surgery plus intraoperative intravenous morphine is an effective technique for decreasing postoperative pain to mild or moderate level within 48 hours and reduces morphine requirement especially in 8 hours after the operation.


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1. Neustein SM, McCormick PJ. Postoperative analgesia after
minimally invasive thoracoscopy: what should we do? Can
J Anaesth 2011;58:423-5.
2. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of
preemptive analgesia for acute postoperative pain
management: a meta-analysis. Anesth Analg 2005;100:757-73.
3. Freise H, Van Aken HK. Risks and benefits of thoracic
epidural anaesthesia. Br J Anaesth 2011;107:859-68.
4. Naja ZM, El-Rajab M, Al-Tannir MA, et al. Thoracic
paravertebral block: influence of the number of injections.
Reg Anesth Pain Med 2006;31:196-201.
5. Romero A, Garcia JE, Joshi GP. The state of the art in
preventing postthoracotomy pain. Semin Thorac Cardiovasc
Surg 2013;25:116-24.
6. Blanco R. TAP block under ultrasound guidance: The
description of a ‘no pops technique’. Reg Anesth Pain Med
7. Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A,
Gadsden J. Essentials of our current understanding:
abdominal wall blocks. Reg Anesth Pain Med 2017;42:133-83.
8. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic
efficacy of pre-operative bilateral erector spinae plane (ESP)
blocks in patients having ventral hernia repair. Anaesthesia
9. 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
10. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study
investigating the mechanism of action of erector spinae
blockade. Reg Anesth Pain Med 2018;43:567-71.
11. Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH.
Comparison of injectate spread and nerve involvement
between retrolaminar and erector spinae plane blocks in the
thoracic region: a cadaveric study. Anaesthesia 2018;73:
12. 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.
13. Khaled M. Gaballah, Wesameldin A, Soltan, Nadia M. Bahgat.
Ultrasound-guided serratus plane block versus erector
spinae block for postoperative analgesia after videoassisted thoracoscopy: a pilot randomized controlled trial.
J Cardiothorac Vasc Anesth 2019;33:1946-1953.
14. Adhikary SD, Liu WM, Fuller E, Cruz-Eng H, Chin KJ. The
effect of erector spinae plane block on respiratory and
analgesic outcomes in multiple rib fractures: a retrospective
cohort study. Anaesthesia 2019;74:585-93.
15. 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;34:444-9.
16. 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;41:621-7.