Continuous erector spinae plane block (ESP) for thoracotomy in thoracic resective surgery

Abstract

Introduction: Post-operative pain in resective thoracic surgery is one of the most intense. Among the classic analgesic alternatives described for this surgery are thoracic epidural analgesia and paravertebral block. The erector spinae plane block (ESP) consists of an interfascial block that is performed at the level of the transverse process of T5. The main objective of the present study is to present a series of cases that show the analgesic efficacy of ESP block both intra and postoperatively in patients undergoing resective thoracic surgery. Material and Methods: With a 50 mm - 100 mm Pajunk needle and under ultrasound vision, interfascial plane was identified at the level of the transverse process of T5 and a single injection of Levobupivacaine 0.25% 20 cc was performed and a catheter was installed for continuous infusion. Results: 7 patients underwent thoracic surgery, after performing continuous ESP block with catheter installation. We used 0.1% Bupivacaine with a continuous infusion of 2 mL/h, programmed intermittent boluses of 15 mL every 4 hours, and boluses of 5 mL controlled by the patient in case of pain and with a 1-hour blockade. Pain in all patients remained below 3 points on the visual analog scale during the 48-72 postoperative hours, and without the need for rescue opioid analgesics. Discussion: continuous ESP block is a great analgesic alternative for resective thoracic surgery.