Analgesic efficacy of continuous ultrasound-guided unilateral erector spinae block and thoracic epidural analgesia in patients undergoing antero-lateral thoracotomy

Chest physiotherapy and incentive spirometry, essential for pulmonary care, can exacerbate acute post-thoracotomy pain. Pain relief is, therefore, essential to facilitate early mobilization. This study evaluated the analgesic efficacy of unilateral continuous erector spinae block (ESB) compared to thoracic epidural analgesia (TEA) in terms of quality of pain relief and perioperative hemodynamic changes. To compare the analgesic efficacy of continuous ultrasound-guided unilateral ESB and thoracic epidural in patients undergoing antero-lateral thoracotomy. This prospective, observational study was conducted at a tertiary care hospital of central India. Sixty-eight adult patients of either gender, posted for elective thoracic surgeries requiring one lung ventilation, were allocated to either TEA (n = 34) or ESB (n = 34) group, based on the attending anesthesiologist's expertise. Continuous data were analyzed by independent t-tests, and categorical data by χ 2 tests. The proportion of patients requiring rescue opioids within 24 hours post-extubation was similar between the two group. Resting numerical rating scale scores (0 hour, 6 hours, and 72 hours post-extubation) were significantly higher in the ESB group compared to the TEA group [1.70 ± 1.03 vs 1.05 ± 0.77 (P = 0.004); 1.64 ± 0.98 vs 1.2 ± 0.88 (P = 0.05); 3.2 ± 1.07 vs 2.61 ± 0.92 (P = 0.013)]. Dynamic numerical rating scale scores and post-extubation mean arterial pressures were also higher in the ESB group. Additionally, block performance time was significantly longer in the ESB group (16.58 ± 3.66 vs 13.84 ± 2.88, P = 0.001). The two techniques provided similar opioid-sparing effects following antero-lateral thoracotomy, though TEA exhibited a superior analgesic efficacy at the expense of increased hemodynamic instability requiring vasopressor support.