Omar Chaudhary1, Yanick Baribeau1, Ivan Urits1, Aidan Sharkey1, Rayan Rashid1, Philip Hess1, Santiago Krumm1, Huma Fatima2, Qianqian Zhang1, Sidharta Gangadharan3, Feroze Mahmood1, Robina Matyal4. 1. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 2. Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 3. Department of Surgery, Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 4. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: rmatyal1@bidmc.harvard.edu.
Abstract
BACKGROUND: Ultrasound guidance has resulted in a continuous evolution in techniques for pain control for video assisted thoracoscopic surgery (VATS). The objective of this study was to compare Erector Spinae Plane blocks (ESP) with intercostal blocks (ICB) as part of multi-modal analgesia in quality of postoperative pain control and preservation of pulmonary function after VATS. METHODS: A consecutive cohort of patients undergoing elective VATS were enrolled in the study and divided into the ESP and ICB block groups. Spirometry and visual analog pain scores (VAS) exams were performed to measure Forced Vital Capacity (FVC), Forced Expiratory Volume at one second (FEV1), FEV1/FVC ratio, and Forced Expiratory Flow in intervals 25% to 75% (FEF25-75). Chronic pain was assessed by reviewing the surgical follow up note. RESULTS: A total of 78 patients were included. Comparing ESP with ICB groups there was significant improvement in VAS pain score (3.2 vs 6.4; p < .001), post anesthesia care unit length of stay (127.3 vs 189.5 minutes; p = 0.045), preservation in lung volume parameters at 2 hours; FVC (40.5% vs 51.4%, p < 0.001), FEV1 (40.9% vs 53.8%, p < 0.001), and FEF25-75( 39.7% vs 53.7%, p = 0.019) and 24 hours FVC (37.8% vs 50.5%, p < 0.001), FEV1( 34.3% vs 51.9%, p < .0001), FEF25-75 (27.1% vs 56.3%, p <.0001) respectively. CONCLUSIONS: Erector spinae plane block improves acute as well as chronic pain control and preserves lung function, thus it has a potential for enhanced recovery from VATS as part of a multi-modal analgesia.
BACKGROUND: Ultrasound guidance has resulted in a continuous evolution in techniques for pain control for video assisted thoracoscopic surgery (VATS). The objective of this study was to compare Erector Spinae Plane blocks (ESP) with intercostal blocks (ICB) as part of multi-modal analgesia in quality of postoperative pain control and preservation of pulmonary function after VATS. METHODS: A consecutive cohort of patients undergoing elective VATS were enrolled in the study and divided into the ESP and ICB block groups. Spirometry and visual analog pain scores (VAS) exams were performed to measure Forced Vital Capacity (FVC), Forced Expiratory Volume at one second (FEV1), FEV1/FVC ratio, and Forced Expiratory Flow in intervals 25% to 75% (FEF25-75). Chronic pain was assessed by reviewing the surgical follow up note. RESULTS: A total of 78 patients were included. Comparing ESP with ICB groups there was significant improvement in VAS pain score (3.2 vs 6.4; p < .001), post anesthesia care unit length of stay (127.3 vs 189.5 minutes; p = 0.045), preservation in lung volume parameters at 2 hours; FVC (40.5% vs 51.4%, p < 0.001), FEV1 (40.9% vs 53.8%, p < 0.001), and FEF25-75( 39.7% vs 53.7%, p = 0.019) and 24 hours FVC (37.8% vs 50.5%, p < 0.001), FEV1( 34.3% vs 51.9%, p < .0001), FEF25-75 (27.1% vs 56.3%, p <.0001) respectively. CONCLUSIONS: Erector spinae plane block improves acute as well as chronic pain control and preserves lung function, thus it has a potential for enhanced recovery from VATS as part of a multi-modal analgesia.
Authors: Severin Schmid; Mohamad Kaafarani; Gabriele Baldini; Alexander Amir; Florin Costescu; Danielle Shafiepour; Jonathan Cools-Lartigue; Sara Najmeh; Christian Sirois; Lorenzo Ferri; David Mulder; Jonathan Spicer Journal: J Thorac Dis Date: 2021-11 Impact factor: 2.895