Comparative Study between Costotransverse Block and Erector Spinae Plane Block for Postoperative Analgesia in Patients Undergoing Thoracotomy: Review Article

Background: Despite the initial belief that epidural analgesia was the most effective way to treat pain after a thoracotomy, due to the significant risk of dural puncture, nerve lesions, epidural hematoma, and hypotension, it is not advised for pain management following thoracotomy surgery. Following thoracic procedures including thoracotomy and mastectomy, well-established and well-recognized methods for postoperative analgesia include thoracic paravertebral block (TPVB) and intercostal nerve block (ICB). They can provide equivalent analgesic effectiveness and fewer side effects, making them a legitimate substitute for epidural blocks. However, because the injection site's borders are still near important organs, they need to be handled with more skill to ensure safety. It has been shown that erector spinae plane block (ESPB) is a successful postoperative analgesic method for a variety of procedures. According to reports, it was anticipated that local anesthetics (LA) in ESPB would act on the dorsal and ventral rami of the spinal neurons and spread to the paravertebral region. Objective: This article aimed to compare the analgesic efficacy ofcostotransverse block (CTB) and ESPB for postoperative analgesia in patients undergoing thoracotomy as a primary outcome. Methods: We searched PubMed, Google Scholar, and Science Direct for Costotransverse Block, ESPB, Postoperative Analgesia and Thoracotomy. Only the most recent or thorough investigation, from 2018 to 2024, was taken into account. The writers evaluated relevant literature references as well. Documents written in languages other than English have been ignored. Papers that were not regarded as significant scientific research included dissertations, oral presentations, conference abstracts, and unpublished manuscripts were excluded. Conclusions: Acute postoperative pain following thoracic surgery increases the risk of chronic postsurgical pain (PSP) and lowers quality of life. Regional anesthesia, when used as part of multimodal analgesia, can effectively manage pain, reduce the need for anesthetic and perioperative analgesic medications, decrease postoperative nausea and vomiting, decrease the risk of chronic pain, postoperative respiratory complications, shorten hospital stays, and improve patient satisfaction. As part of a multimodal analgesic regimen for various operations, TPVB and ESPB can be utilized to address acute PSP. As a reliable technique for postoperative analgesia in thoracic surgeries, thoracic PVB is advised by the improved recovery after surgery protocol.