Analgesic efficacy of continuous ultrasound-guided unilateral erector spinae block and thoracic epidural analgesia in patients undergoing antero-lateral thoracotomy

Abstract

BACKGROUND

Chest physiotherapy and incentive spirometry, essential for pulmonary care, can exacerbate acute post-thoracotomy pain. Pain relief is, therefore, essential to facilitate early mobilization. This study evaluated the analgesic efficacy of unilateral continuous erector spinae block (ESB) compared to thoracic epidural analgesia (TEA) in terms of quality of pain relief and perioperative hemodynamic changes.

AIM

To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy.

METHODS

This prospective, observational study was conducted at a tertiary care hospital of central India. Sixty-eight adult patients of either gender, posted for elective thoracic surgeries requiring one lung ventilation, were allocated to either TEA (n = 34) or ESB (n = 34) group, based on the attending anesthesiologist’s expertise. Continuous data were analyzed by independent t-tests, and categorical data by χ² tests.

RESULTS

The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group. Resting numerical rating scale scores (0 hour, 6 hours, and 72 hours post-extubation) were significantly higher in the ESB group compared to the TEA group [1.70 ± 1.03 vs 1.05 ± 0.77 (P = 0.004); 1.64 ± 0.98 vs 1.2 ± 0.88 (P = 0.05); 3.2 ± 1.07 vs 2.61 ± 0.92 (P = 0.013)]. Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group. Additionally, block performance time was significantly longer in the ESB group (16.58 ± 3.66 vs 13.84 ± 2.88, P = 0.001).

CONCLUSION

The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy, though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.

Keywords: Epidural analgesia; Erector spinae plane block; Opioid; Pain management; Postoperative pain; Thoracotomy; Ultrasonography

Core Tip: This prospective study compared the analgesic efficacy of unilateral continuous erector spinae block (ESB) vs thoracic epidural analgesia (TEA) in patients undergoing thoracotomy, evaluating pain scores and perioperative hemodynamics. While rescue opioid requirements within 24 hours post-extubation were comparable between the two groups, resting numerical rating scale scores at 0 hour, 6 hours, and 72 hours were significantly higher in the ESB cohort. Hemodynamically, the ESB group maintained higher mean arterial pressures, whereas TEA was associated with greater hypotensive episodes, necessitating significantly more vasopressor support to sustain mean arterial pressures ≥ 65 mmHg at 0 hours and 6 hours. Although TEA demonstrates superior analgesia, its use is limited by increased hemodynamic instability, suggesting ESB as a viable alternative when cardiovascular compromise is a concern.