<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Background</h3>
<p>A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided <italic>erector spinae</italic> plane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB).</p>
</sec>
<sec><h3>Patients and methods</h3>
<p>A prospective randomized-control study was performed to compare outcomes of patients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h.</p>
</sec>
<sec><h3>Results</h3>
<p>60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21. 64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 <italic>vs.</italic> 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups.</p>
</sec>
<sec><h3>Conclusions</h3>
<p>In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative complications, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.</p>
</sec>
</abstract>

Background
A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study aims to critically assess the continuous ultrasound-guided erector spinae plane block (ESPB) at our institution and compare it to a standard regional anesthetic technique, the intercostal nerve block (ICNB).

Patients and methods
A prospective randomized-control study was performed to compare outcomes of patients, scheduled for video-assisted thoracoscopic (VATS) lung cancer resection, allocated to the ESPB or ICNB group. Primary outcomes were total opioid consumption and subjective pain scores at rest and cough each hour in 48 h after surgery. The secondary outcome was respiratory muscle strength, measured by maximal inspiratory and expiratory pressures (MIP/MEP) after 24 h and 48 h.

Results
60 patients met the inclusion criteria, half ESPB. Total opioid consumption in the first 48 h was 21. 64 ± 14.22 mg in the ESPB group and 38.34 ± 29.91 mg in the ICNB group (p = 0.035). The patients in the ESPB group had lower numerical rating scores at rest than in the ICNB group (1.19 ± 0.73 vs. 1.77 ± 1.01, p = 0.039). There were no significant differences in MIP/MEP decrease from baseline after 24 h (MIP p = 0.088, MEP p = 0.182) or 48 h (MIP p = 0.110, MEP p = 0.645), time to chest tube removal or hospital discharge between the two groups.

Conclusions
In the first 48 h after surgery, patients with continuous ESPB required fewer opioids and reported less pain than patients with ICNB. There were no differences regarding respiratory muscle strength, postoperative complications, and time to hospital discharge. In addition, continuous ESPB demanded more surveillance than ICNB.

Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgery

Faculty of Computer and Information Science

Faculty of Mathematics, Natural Sciences and Information Technologies

Radiology and Oncology

This work is licensed under the Creative Commons Attribution 4.0 International License.

Background
A recent trend in postoperative analgesia for lung cancer surgery relies on regional nerve blocks with decreased opioid administration. Our study...

Respiratory test values (%)		ESPB	ICNB	p-value
MIP	24 hours	71.58 ± 16.69	75.98 ± 24.04	0.088
	48 hours	73.42 ± 19.10	88.11 ±30.72	0.110
MEP	24 hours	73.36 ± 20.82	85.55 ± 37.35	0.182
	48 hours	74.90 ± 22.39	98.90 ± 32.29	0.645

	Total	ESPB	ICNB	p-value
Patients enrolled	50	25	25
Gender (male/female)	30/20	17/8	13/12	0.25
Age (years)^*	69.80 ± 8.41	69.44 ± 8.20	70.2 ± 8.76	0.53
Height (cm)^*	170.20 ± 8.49	172.04 ± 8.01	168.36 ± 8.72	0.15
Weight (kg)^*	76.62 ± 14.07	76.24 ± 14.36	77.00 ± 14.03	0.72
BMI (kg/m²)^*	26.37 ± 3.93	25.72 ± 4.18	27.03 ± 3.64	0.21
ASA 1/2/3	1/25/24	0/14/11	1/11/13	0.47
FEV1 before the surgery	94.78 ± 21.57	95.45 ± 21.84	94.17 ±21.77	0.88

Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgery

Article Category: Research Article

Published Online: Sep 04, 2023

Page range: 364 - 370

Received: Dec 11, 2022

Accepted: Jan 16, 2023

DOI: https://doi.org/10.2478/raon-2023-0035

Keywords
erector spinae plane block, intercostal nerve block, postoperative analgesia, video-assisted thoracic surgery, thoracic anesthesia

© 2023 Polona Gams et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

FIGURE 2.

FIGURE 3.

FIGURE 4.

Maximal inspiratory and expiratory muscle strength

Demographic data

Erector spinae plane block versus intercostal nerve block for postoperative analgesia in lung cancer surgery

Article Category: Research Article

Published Online: Sep 04, 2023

Page range: 364 - 370

Received: Dec 11, 2022

Accepted: Jan 16, 2023

DOI: https://doi.org/10.2478/raon-2023-0035

Keywordserector spinae plane block, intercostal nerve block, postoperative analgesia, video-assisted thoracic surgery, thoracic anesthesia

© 2023 Polona Gams et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

FIGURE 2.

FIGURE 3.

FIGURE 4.

Maximal inspiratory and expiratory muscle strength

Demographic data

Keywords
erector spinae plane block, intercostal nerve block, postoperative analgesia, video-assisted thoracic surgery, thoracic anesthesia