Erector Spinae Plane Block for Video-Assisted Thoracoscopic Surgery

Efficacy of ESP Block for VATS

Single-shot erector spinae plane (ESP) block with 20 ml bupivacaine 5 mg/ml provides effective analgesia with reduced pain scores and opioid consumption during the first 24 hours postoperatively for patients undergoing video-assisted thoracoscopic surgery (VATS) 1, 2
ESP block significantly reduces pain scores at rest and during coughing for the first 6-8 hours after VATS surgery compared to placebo or no block 1, 2
Patients receiving ESP blocks demonstrate lower opioid consumption during the first 24 hours postoperatively 2

A single injection at T4-T6 level is recommended rather than multiple injections, as multiple injections (T4-T8) have not demonstrated superior analgesia but increase procedural time and patient discomfort 1, 3
The recommended volume is 20 ml of bupivacaine 5 mg/ml for single-shot ESP block 2, 3

ESP block and paravertebral block show comparable efficacy in terms of pain scores and opioid consumption during the first 48 hours postoperatively 2, 3
Some studies suggest paravertebral block may provide superior analgesia compared to ESP block in the first 8 hours after surgery 2, 3

Adding dexmedetomidine to ropivacaine in ESP block results in reduced pain scores, lower rescue analgesia requirements, and shorter hospital stays compared to plain ropivacaine or ropivacaine with dexamethasone 3
The addition of adjuvants should be considered when prolonged analgesia is required 3

No significant difference has been found between blocks performed after incision or at the end of the procedure in terms of pain score and opioid consumption 1

Patients receiving ESP block demonstrate faster postoperative out-of-bed activity 1, 2

The analgesic effect of single-shot ESP block may diminish after 6-8 hours, requiring supplemental analgesia 2, 3
Basic analgesia with NSAIDs and paracetamol should be administered concurrently with ESP block to optimize pain management 1, 2
ESP block may provide less consistent analgesia compared to paravertebral block in some patients, requiring careful assessment of individual pain control 2, 3