ERECTOR SPINAE PLANE BLOCK CATHETER: A GOAL STANDARD FOR THORACIC ANAESTHESIA?

Abstract

<h3>Background</h3> Recent advances in Enhanced Recovery post Thoracic surgery has introduced various fascial plane blocking techniques that block dorsal, lateral, and anterior cutaneous nerves of the thorax and abdomen. Erector spinae plane (ESP) block is a relatively novel truncal nerve plane block increasing used in thoracic analgesia. Blockage of dorsal and ventral rami of the thoracic nerves allows for effective pain management post open thoracotomies and video assisted thoracic surgery. Due to limitation by duration of action of single shot nerve blocks,(paravertebral and ESP block), continuous pain relief using catheters have been widely used with good patient outcome. <h3>Method</h3> Patients undergoing elective and urgent thoracic surgeries under general anaesthesia in a single thoracic and trauma unit in the United Kingdom were appropriately selected based on comorbidities, performance status, and indication plus duration of thoracic surgery. Retrospective data on single shot nerve block injections and patient-controlled analgesia (PCA) use was collected for fifty patients. Prospectively, ESP catheter was inserted in fifty patients by consultant anaesthetist or thoracic surgeon pre procedure and post routine intraoperative anaesthesia care and multimodal analgesia. We compared total opioid consumption, postoperative pain scores (visual analog scale), mobility with physiotherapy, complications, and length of stay. <h3>Results</h3> Forty patients were included in both groups. Five cases were removed due to incomplete data. Total opioid consumption over 24 hours and 48 hours was measured. Total opiod consumption was significantly low in patients receiving continuous ESP catheters. Pain score was lower in the recovery and post operative ward in patients with ESP catheters. Pain nurse review in ESP catheter group day 1 postoperatively allowed for better optimisation of analgesia, improved adherence to documentation of acute pain observation chart. ESP catheter did not affect physiotherapy care and patients completed 100m in less than 48 hours. There was no statistically significant difference in adverse effects between single shot vs catheter patients, however, increased PCA use in single shot blocks contributed to post operative drowsiness and nausea in five patients. <h3>Conclusion</h3> ESP catheter has shown to provide safe and effective analgesia post thoracic surgery while decreasing opioid consumption. We could demonstrate a significant improvement in patient outcome, with the ESP catheters when compared to single shot blocks. Early physiotherapy and good analgesics provided early mobilization and less days in hospital stay and reduced complications. On account of technical ease and low procedural risk of ESP block under ultrasound guidance, it is favorable for use in thoracic surgery compared to more invasive nerve blocks. More education, compliance and multimodal care is required to utilize ESP catheter for successful postoperative pain management.