Erector spinae plane block, neuropathic pain and quality of life after video-assisted thoracoscopy surgery. Pilot, observational study

Abstract

Background: The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. Methods: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. Results: Forty-two patients were enrolled and completed the initial 24-hour follow-up. None of our patients reported CNP. We observed adequate static pain control at 12 and 24 hours postoperatively, with a median numerical rating scale (NRS) score of 3. Dynamic pain was less controlled with a median NRS score of 6 at 12 and 24 hours postoperatively in the treatment group. 24-hour IV morphine equivalents consumption was 5.5 mg. Three months’ follow-up was completed by 35 patients, with QoL assessed as very good by 54.3%. Conclusions: ESPB can be an alternative, effective and reproducible technique for VATS. The low incidence of CNP and “very good” quality of life found in most patients could be related to ESPB. Further comparative studies are needed to evaluate the association between ESPB, CNP and QoL.