The Effect of the Port Numbers Used in Video-assisted Thoracoscopic Surgery on the Success of Ultrasound-Guided Erector Spinae Plane Block; A Single Center Retrospective Study

Abstract

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure with lower pain scores and less morbidity than thoracotomy. However, it is necessary to provide adequate pain control in VATS. For this purpose, blocking visceral and somatic nerve fibers results in successful pain management. This retrospective study evaluated the effect of using different numbers of ports on the success of erector spinae plane block (ESPB) for postoperative analgesia management in patients undergoing VATS. We conducted a retrospective, single-center study between Sep 2020 and Aug 2021. According to the number of ports used, fifty-eight patients were assigned to three groups (single port, dual port, and three-port). Preoperative ultrasound-guided ESPB was performed on all patients. The primary outcome was the numerical rating scale (NRS) score assessed for pain severity at different periods after surgery. The secondary outcome was the postoperative cumulative opioid consumption, and the exploratory outcomes were to determine the length of hospital stay and the incidence of opioid-related side effects. Static and dynamic NRS scores were significantly higher in the three-port group in the first 12-hour postoperative period after admission to the post-anesthesia care unit (p<0.05). After the first 12-hour period after surgery, static and dynamic NRS scores did not differ significantly between the groups (p=0.158 and p=0.125, respectively). Cumulative opioid consumption in the first 24 hours postoperatively was considerably higher in the three-port group than in the other groups (33.04±21.35 mg, p=0.001). Rescue analgesia consumption was similar between all groups (p=0.341). Preoperative single-shot ESPB injection may be associated with better analgesia and less opioid consumption in the first 12 hours postoperatively in patients undergoing single or two-port VATS compared to the multi-port technique.