Continuous Erector Spinae Plane Block as Postoperative Analgesic Technique for Robotic-Assisted Thoracic Surgery: A Case Series

Abstract

Marco Cavaleri,1 Stefano Tigano,1,2 Roberta Nicoletti,1,2 Valeria La Rosa,1,2 Alberto Terminella,3 Giacomo Cusumano,3 Filippo Sanfilippo,1 Marinella Astuto1,2 1Department of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital “G. Rodolico”, University of Catania, Catania, 95123, Italy; 2School of Anaesthesia and Intensive Care, University Hospital “G. Rodolico”, University of Catania, Catania, 95123, Italy; 3Thoracic Surgery Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital “G. Rodolico” - San Marco Hospital, Catania, 95121, ItalyCorrespondence: Marco CavaleriDepartment of General Surgery and Medical-Surgical Specialties, Section of Anaesthesia and Intensive Care, University Hospital “G. Rodolico”, University of Catania, Via Santa Sofia 78, Catania, 95123, ItalyTel [phone]Email [email protected]: The erector spinae plane block (ESPB) is a recently implemented analgesic technique initially reported for thoracic analgesia and subsequently adopted for both intra- and postoperative pain management. Thoracic surgery is among the most painful surgical procedures, even when conducted with minimally invasive approach. Robotic-assisted thoracic surgery (RATS) challenges the traditional analgesic regimens as one of its aims is to decrease the patient’s length of stay (LOS) whilst achieving optimal postoperative pain management. Furthermore, there is lots of growing evidence on the impact of poorly controlled postoperative pain (PP) on the development of chronic post-surgical pain (CPSP). In these case series, we aim to describe our preliminary experience of postoperative pain management with continuous ESPB in the field of RATS.Case Series Presentation: In eight consecutive patients undergoing elective RATS procedure, we performed the ESPB after surgery with an initial bolus of local anesthetic followed by catheter insertion for continuous infusion. The infusion of local anesthetic lasted for the first two postoperative days. The effectiveness of the ESPB was evaluated through serial pain assessment with numeric rate scale (NRS) score, both at rest and during movement every 6 hours. Any analgesic rescue drug prescription was reported. We noted that the ESPB strongly reduced the prescription of opioids and of rescue analgesic. In our series, only one patient needed opioids during the first two postoperative days, and no rescue analgesic administration was noted in the remaining cases.Conclusion: We report a small but promising experience regarding postoperative pain management with continuous ESPB performed after RATS. We implemented the ESPB before surgery. Larger studies on postoperative pain management with continuous regional blocks in thoracic surgery are warranted.Keywords: pain management, regional block, thoracic surgery, postoperative care

Keywords

• pain management
• regional block
• thoracic surgery
• postoperative care