Preoperative thoracic epidural analgesia with and without erector spinae plane block for thoracotomy: A retrospective study

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BACKGROUND: Thoracotomy is a highly painful surgical procedure, with thoracic epidural analgesia (TEA) serving as the gold standard for postoperative pain management. However, TEA can induce significant hypotension, especially when combined with general anesthesia. The ultrasound-guided erector spinae plane block (ESPB) has emerged as a complementary technique for enhancing analgesia while minimizing side effects. This study compares the analgesic efficacy and intraoperative hemodynamic outcomes of preoperative TEA with and without ESPB in patients undergoing thoracotomy. METHODS: This retrospective cohort study was conducted at a tertiary university hospital, including patients who underwent thoracotomy for tumor resection between March 2017 and March 2023. Patients receiving ESPB prior to TEA were compared with those receiving TEA alone. Postoperative pain intensity and intraoperative hemodynamic stability were assessed. The primary outcome was postoperative pain scores, while secondary outcomes included intraoperative mean arterial pressure and postoperative outcomes such as length of hospital stay. RESULTS: A total of 64 patients were enrolled in the study, including 43 who received TEA alone and 21 who received a combination of TEA and ESPB. After propensity score matching, 21 patients were matched 1:1 in each group for comparative analysis. Patients who received ESPB in addition to TEA had significantly lower pain scores at 1 h and 24 h postoperatively (p < 0.001). Additionally, they demonstrated higher intraoperative mean arterial pressures (p = 0.036) compared to the TEA-only group. However, there were no significant differences in postoperative outcomes. CONCLUSION: The combination of preoperative ESPB and TEA provides superior early postoperative pain control and enhances intraoperative hemodynamic stability in thoracotomy patients compared to TEA alone.

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