# Association of Erector Spinae Plane Block on Quality of Postoperative Recovery in Patients Undergoing Video-Assisted Thoracoscopic Surgery: An Observational Cohort Study

## TL;DR

This study explores whether adding a specific type of regional anesthesia improves recovery after a type of chest surgery.

## Contribution

The study evaluates the impact of erector spinae plane block on postoperative recovery quality in VATS patients using observational data.

## Key findings

- ESPB was associated with a higher proportion of patients achieving good-to-excellent recovery scores.
- No significant differences were found in pain scores, complications, or hospitalization length between groups.
- ESPB did not increase anesthesia time or perioperative risk.

## Abstract

Introduction: Video-assisted thoracoscopic surgery (VATS) reduces surgical trauma compared to thoracotomy, but postoperative pain and recovery remain important concerns. The erector spinae plane block (ESPB) is a promising regional anesthesia technique, yet its impact on patient-centered outcomes, such as quality of recovery, remains underexplored.

Methods: In this prospective observational study, 54 patients undergoing elective VATS at a tertiary center were included. Patients received either an ultrasound-guided ESPB plus the institutional protocol of general anesthesia with intercostal nerve block (Group A, n=37) or the standard protocol alone (Group B, n=17). The primary endpoint was the Quality of Recovery-15 (QoR-15) score at 24 hours postoperatively, assessed numerically and by severity classification. Secondary endpoints included intraoperative and postoperative complications, length of hospitalization (in days), and numeric pain score at 24 hours postoperatively.

Results: The mean QoR-15 score was 103.4±2.6, with no significant difference between groups (t=1.04, df=52, Cohen's d=0.31, 95% CI -0.27 - 0.88, p=0.302). However, severity classification analysis showed a significant improvement (U=225.0, Z=-1.97, r=0.27, p=0.049). In Group A, 21.6% (n=8) achieved good/excellent recovery compared to none in Group B, and fewer patients were classified as poor recovery (16.2%, n=6 vs. 29.4%, n=5). No differences were observed in intraoperative and postoperative complications, numeric pain score at 24 hours postoperatively, or length of hospitalization. Importantly, ESPB did not increase anesthesia time or perioperative risk.

Conclusion: Adding ESPB to multimodal analgesia was associated with a trend toward improved postoperative quality of recovery after VATS, with a higher proportion of patients achieving good-to-excellent QoR-15 scores. These findings suggest that ESPB may be a safe and useful adjunct to enhance recovery after VATS; however, these findings require confirmation in larger randomized studies.