Analgesic Efficacy of Erector Spinae Plane Block in Thoracic Surgery

Abstract

Introduction: Erector spinae plane block (ESPB) is a novel regional anesthesia technique for thoracic surgery, but its efficacy relative to thoracic epidural analgesia (TEA) or paravertebral block (PVB) is uncertain.
Methods: A literature review (2018–2024) identified RCTs and observational studies comparing ESPB to TEA, PVB, or systemic analgesia in adults undergoing thoracotomy or video-assisted thoracic surgery (VATS). Primary outcome: postoperative opioid consumption at 24 hours.
Results: Thirteen studies (n=1,052) showed ESPB reduced 24-hour morphine consumption by 8 mg vs. systemic analgesia (p<0.001) but had higher consumption than TEA (difference +5 mg, p=0.02) and PVB (non-significant). Pain scores (VAS) were comparable to PVB but higher than TEA at 12 hours. Complications (hypotension, urinary retention) were lowest with ESPB.
Discussion: ESPB provides effective analgesia for VATS and moderate thoracotomy, with safety advantages over TEA (no sympathectomy). Lower analgesic potency may reflect limited ventral spread.
Conclusions: ESPB is a safe, opioid-sparing alternative to TEA and PVB, particularly for minimally invasive thoracic surgery. Further studies should optimize local anesthetic volume and catheter techniques.