Effectiveness and Safety of Erector Spinae Plane Block vs. Conventional Pain Treatment Strategies in Thoracic Surgery

<b>Background:</b> An erector spinae plane block (ESPB) has gained popularity due to its effectiveness and simplicity for pain relief. However, it is uncertain whether an ESPB provides superior analgesia after a VATS or thoracotomy compared to other regional and systemic analgesic techniques. <b>Methods:</b> A retrospective cohort study was conducted from January to June 2023 comparing an ESPB with intravenous combination analgesia (IV-CA) in VATS patients and with thoracic epidural analgesia (TEA) in thoracotomy patients. The primary endpoint was the opioid demand during the first two hours in the post-anesthesia care unit (PACU). The secondary outcomes included the pain scores and adverse events. <b>Results:</b> A total of 61.2% of the 165 included VATS patients and 56.9% of the 72 thoracotomy patients were treated with an ESPB. Following a VATS, an ESPB decreased the median piritramide demand (7.5 [3.0 to 12.0] vs. 10.5 [6.5 to 15.5] mg, <i>p</i> < 0.01). However, after a thoracotomy, an ESPB increased the median piritramide demand (12.0 [6.0 to 15.0] vs. 3.0 [0.0 to 9.0] mg, <i>p</i> < 0.01). The pain scores and adverse events were similar between the groups. <b>Conclusions:</b> An ESPB reduces the piritramide demand in VATS patients compared with IV-CA, providing similar pain relief. However, in thoracotomy patients, an ESPB is associated with an increased piritramide demand compared to TEA. An ESPB is an attractive add-on to IV-CA after a VATS, while TEA remains the gold standard after a thoracotomy.