Thoracic Spinal Anesthesia With Erector Spinae Plane Block Versus Conscious Sedation for Medical Thoracoscopy: A Comparative Pilot Study

TL;DR

This study compares two anesthesia techniques for medical thoracoscopy, finding that thoracic spinal anesthesia with erector spinae plane block improves recovery and reduces pain.

Contribution

The study introduces a novel anesthetic combination of TSA with ESPB for medical thoracoscopy, showing improved patient outcomes.

Findings

Patients receiving TSA with ESPB had significantly higher quality of recovery scores compared to those with conscious sedation.

The TSA with ESPB group required less opioid consumption and had longer time to first analgesic use.

Procedure duration was shorter in the TSA with ESPB group without anesthesia-related complications.

Abstract

Background and objective

Medical thoracoscopy (MT) is associated with significant postoperative pain of varying intensity and duration, leading to significant morbidity. Our study compared the efficacy of thoracic spinal anesthesia (TSA) combined with erector spinae plane block (ESPB) with conscious sedation for MT using a patient-centered outcome measure.

Methods

This is a non-randomized prospective comparative pilot study wherein 36 patients undergoing MT were assigned alternately to receive TSA with ESPB or conscious sedation. Conscious sedation was administered with fentanyl and midazolam in graded doses with local instillation of lignocaine 2%. TSA was administered at the T6-T7 level with 25 mcg of fentanyl and 0.5% levobupivacaine (1.5 ml), followed by ESPB with 0.25% levobupivacaine (10 ml). The primary outcome was to compare the efficacy of ESPB with conscious sedation in terms of quality of recovery. The secondary outcome was to compare the time to administration of the first analgesic post procedure, total postoperative opioid consumption (mg) at 24 hours, and duration of the procedure. Intraoperative hemodynamic stability and block-related and post-procedure complications were also assessed.

Results

The total Quality of Recovery-15 (QoR-15) score was 112.83 ± 27.16 vs. 65.78 ± 22.13 (p = 0.0001), time to first analgesic was 11.69 ± 6.93 hours vs. 2.39 ± 1.69 hours (p = 0.0001), opioid consumption was 50 ± 10 vs. 75 ± 15 (p = 0.001), and the mean duration of the procedure was 64.72 vs. 93.89 minutes (p = 0.0001) in the ESPB group and the conscious sedation group, respectively. No block/anesthesia-related complications were reported in either group.

Conclusion

The combination of TSA with ESPB can be a novel, effective, and safe anesthetic technique for MT, offering better quality of recovery, improved postoperative analgesia, shorter procedure duration, and reduced perioperative morbidity.

Figures