Erector spinae plane block improves postoperative analgesia and pulmonary function recovery after thoracoscopic lobectomy: a retrospective cohort study

Background Postoperative pain management following thoracoscopic lobectomy remains challenging, potentially impairing pulmonary function and recovery. This study evaluated the effects of ultrasound-guided erector spinae plane block (ESPB) on pain control and pulmonary function in these patients. Methods This retrospective cohort study included 120 patients who underwent thoracoscopic lobectomy between January 2022 and December 2024 at a tertiary care center. Patients received either ultrasound-guided ESPB with 0.375% ropivacaine ( n = 60) or conventional analgesia alone ( n = 60). All patients received standardized general anesthesia and patient-controlled analgesia with morphine postoperatively. Primary outcomes included 0–10 visual analog scale (VAS) pain scores at 1, 6, 12, and 24 h and pulmonary function parameters (FEV 1 , FVC) on postoperative days 1 and 3. Secondary outcomes included morphine consumption, time to first analgesic request, complications, hospital stay, and patient satisfaction. Results The ESPB group demonstrated significantly lower VAS scores at all-time points compared to controls (24-h VAS: 3.2 vs. 5.6; p < 0.001; Cohen’s d = 1.91). Total 24-h morphine consumption was reduced by 42.6% in the ESPB group (20.5 mg vs. 35.7 mg; p < 0.001). Pulmonary function was significantly better preserved in the ESPB group, with higher FEV 1 and FVC values on postoperative days 1 and 3 (all p < 0.01). Pain scores negatively correlated with pulmonary function parameters across the entire cohort, independent of group ( r = –0.45 to –0.50; p < 0.001). Hospital stay was shorter (5.2 vs. 6.5 days; p = 0.001) and patient satisfaction higher (4.5 vs. 3.8; p < 0.001) in the ESPB group. Complication rates were comparable between groups. Conclusion Ultrasound-guided ESPB enhances postoperative pain control and pulmonary function recovery without added risks, supporting its integration into multimodal analgesia protocols for thoracoscopic lobectomy.