Erector Spinae Plane Block versus Paravertebral Block after Thoracic Surgery for Lung Cancer: A Propensity Score Study

SIMPLE SUMMARY: One of the major issues in thoracic surgery is adequate post-operative pain management. Inadequate management leads to complications, such as atelectasis, pneumonia, respiratory failure, and the development of chronic pain. Paravertebral block (PVB) has now become the first-line locoregional technique for video-assisted thoracic surgery (VATS) or robot-assisted thoracic surgery (RATS). New chest wall blocks, such as the erector spinae plane block (ESPB) have been described in recent years to facilitate analgesia and limit the risk of puncturing adjacent structures (neuroaxial, pleural, or vascular punctures). The ESPB is more superficial than the PVB and some studies suggest that the anesthetic could spread into the thoracic paravertebral space. Therefore, the ESPB may have fewer complications and be more effective than PVB. We hypothesize that the ESPB could decrease post-operative pain compared to PVB block after VATS or RATS for lung cancer. ABSTRACT: Introduction: The prevention of respiratory complications is a major issue after thoracic surgery for lung cancer, and requires adequate post-operative pain management. The erector spinae plane block (ESPB) may decrease post-operative pain. The objective of this study was to evaluate the impact of ESPB on pain after video or robot-assisted thoracic surgery (VATS or RATS). Methods: The main outcome of this retrospective study with a propensity score analysis (PSA) was to compare the post-operative pain at 24 h at rest and at cough between a group that received ESPB and a group that received paravertebral block (PVB). Post-operative morphine consumption at 24 h and complications were also assessed. Results: One hundred and seven patients were included: 54 in the ESPB group and 53 in the PVB group. The post-operative median pain score at rest and cough was lower in the ESPB group compared to the PVB group at 24 h (respectively, at rest 2 [1; 3.5] vs. 2 [0; 4], p = 0.0181, with PSA; ESPB −0.80 [−1.50; −0.10], p = 0.0255, and at cough (4 [3; 6] vs. 5 [4; 6], p = 0.0261, with PSA; ESPB -1.48 [−2.65; −0.31], p = 0.0135). There were no differences between groups concerning post-operative morphine consumption at 24 h and respiratory complications. Conclusions: Our results suggest that ESPB is associated with less post-operative pain at 24 h than PVB after VATS or RATS for lung cancer. Furthermore, ESPB is an acceptable and safe alternative compared to PVB.