Assessment of the effectiveness of continuous erector spinae plane block versus continuous thoracic epidural analgesia following major thoracic surgery

BACKGROUND: Acute postoperative pain results from the physiological response to surgical stress. Without adequate management, it may not only contribute to early negative outcomes but also increase the risk of chronic postoperative pain. Despite numerous studies, the optimal postoperative analgesic strategy in thoracic surgery remains undefined. AIM: To perform a comparative assessment of the analgesic effectiveness of continuous erector spinae plane block as part of multimodal analgesia versus continuous thoracic epidural analgesia within a multimodal pain management protocol in patients undergoing extensive thoracic surgery. METHODS: This prospective randomized study was based on the analysis of analgesia quality and intensity in the early postoperative period in 66 patients who underwent thoracic surgery. Patients received either continuous ultrasound-guided erector spinae plane block (ESPB) in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol, or continuous thoracic epidural analgesia combined with NSAIDs and paracetamol. Pain intensity was assessed using the visual analog scale (VAS) at rest, during movement, and while coughing at 24 h, 72 h, and postoperative day 7. Vital capacity (VC) and peak expiratory flow were assessed at all stages of the study. The study evaluated the impact of the analgesic techniques on blood levels of C-reactive protein, substance P, interleukin-6, and tumor necrosis factor alpha as indirect markers of analgesic effectiveness. RESULTS: On postoperative day 1, VAS scores for pain during movement and coughing were significantly lower in the study group (30 mm) compared to the control group (30 mm during movement and 40 mm during coughing; p=0.0004). No significant between-group differences in pain intensity during movement and coughing were found at 72 h or day 7 after operation. No significant between-group differences in inflammatory markers were observed at any time point. VC values decreased to 2.9 L on day 1 in both groups (p 0.01). By postoperative day 7, VC values returned to baseline in both groups: 3.6 L in the study group and 3.6 L in the control group (p 0.01). CONCLUSION: Continuous ESPB ensures effective analgesia in the early postoperative period in patients after open thoracic surgery, comparable in efficacy to thoracic epidural analgesia, and may be used as an alternative.