Effectiveness of the erector spinae plane block for analgesia in lung resection surgery: a prospective randomized controlled trial

Background. Lung resection procedures performed via a conventional thoracotomy are associated with substantial surgical trauma and pronounced postoperative pain. Providing adequate perioperative analgesia for such interventions remains a significant challenge for anesthesiologists. In thoracic surgery, the use of regional analgesia techniques is considered appropriate. The erector spinae plane (ESP) block is a relatively novel regional analgesia technique, the effectiveness of which — particularly in thoracic surgery — requires further investigation. The purpose is to evaluate the effectiveness of the ESP block for analgesia in lung resection surgery performed via a conventional thoracotomy, in comparison with thoracic epidural analgesia (TEA) and analgesia without regional techniques. Materials and methods. A prospective randomized controlled study was conducted involving 131 patients undergoing lung resection. They were randomly assigned to three groups: group A — TEA, group B — ESP block, and group C — no regional analgesia (controls). Pain intensity was assessed using the visual analog scale at rest and during deep inspiration; sleep quality was evaluated using a five-point scale over the first three postoperative days. Markers of stress response (glucose and cortisol) were measured intraoperatively and postoperatively, and cumulative postoperative morphine consumption was recorded. Results. Postoperative pain intensity was significantly lower in the TEA and ESP block groups compared to the control one. Levels of stress-response markers did not differ significantly between groups. Sleep quality was superior in the TEA group on the third postoperative day. Postoperative morphine requirements were lower in the TEA and ESP block groups than in the group without regional analgesia. Conclusions. The ESP block is an effective component of perioperative analgesia for thoracic surgery and may be considered an alternative regional analgesia technique in patients with contraindications to thoracic epidural analgesia.