Gökhan SERTÇAKACILAR, Güneş Özlem YILDIZ, İpek BOSTANCI, Zafer CUKUROVA, Gülsüm Oya HERGÜNSEL

The Effect of the Port Numbers Used in Video-assisted Thoracoscopic Surgery on the Success of Ultrasound-Guided Erector Spinae Plane Block; A Single Center Retrospective Study

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure with lower pain scores and less morbidity than thoracotomy. However, it is necessary to provide adequate pain control in VATS. For this purpose, blocking visceral and somatic nerve fibers results in successful pain management. This retrospective study evaluated the effect of using different numbers of ports on the success of erector spinae plane block (ESPB) for postoperative analgesia management in patients undergoing VATS. We conducted a retrospective, single-center study between Sep 2020 and Aug 2021. According to the number of ports used, fifty-eight patients were assigned to three groups (single port, dual port, and three-port). Preoperative ultrasound-guided ESPB was performed on all patients. The primary outcome was the numerical rating scale (NRS) score assessed for pain severity at different periods after surgery. The secondary outcome was the postoperative cumulative opioid consumption, and the exploratory outcomes were to determine the length of hospital stay and the incidence of opioid-related side effects. Static and dynamic NRS scores were significantly higher in the three-port group in the first 12-hour postoperative period after admission to the post-anesthesia care unit (p<0.05). After the first 12-hour period after surgery, static and dynamic NRS scores did not differ significantly between the groups (p=0.158 and p=0.125, respectively). Cumulative opioid consumption in the first 24 hours postoperatively was considerably higher in the three-port group than in the other groups (33.04±21.35 mg, p=0.001). Rescue analgesia consumption was similar between all groups (p=0.341). Preoperative single-shot ESPB injection may be associated with better analgesia and less opioid consumption in the first 12 hours postoperatively in patients undergoing single or two-port VATS compared to the multi-port technique.

Keywords:

Video-assisted thoracoscopic surgery, Erector spinae plane block, Multiport, Single port, Ultrasound,

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1. Landreneau RJ, Mack MJ, Hazelrigg SR, Naunheim K, Dowling RD, Ritter P, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg 1994;107(4):1079-86.
2. Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hürtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 2016;49(2):602-9.
3. McKenna RJ, Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 2006;81(6):421-426
4. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77(2):726-728.
5. Kaplowitz J, Papadakos PJ. Acute pain management for video-assisted thoracoscopic surgery: an update. J Cardiothorac Vasc Anesth 2012;26(2):312-321.
6. Abd-Elshafy SK, Abdallal F, Kamel EZ, Edwar H, Allah EA, Maghraby HHM, et al. Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention. Pain Physician 2019;22(3):271-280.
7. Yeung JH, Gates S, Naidu BV, Wilson MJ, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2(2):CD009121.
8. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41(5):621-627.
9. Chin KJ. Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence. Best Pract Res Clin Anaesthesiol. 2019;33(1):67-77.
10. Gürkan Y, Aksu C, Kus A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth. 2018;50:65-8.
11. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101-6.
12. Shim JG, Ryu KH, Kim PO, Cho EA, Ahn JH, Yeon JE, et al. Evaluation of ultrasound-guided erector spinae plane block for postoperative management of video-assisted thoracoscopic surgery: a prospective, randomized, controlled clinical trial. J Thorac Dis. 2020;12(8):4174-4182.
13. Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020;59:84-88.
14. Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Clin Anesth. 2020;59:106-111.
15. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study. Reg Anesth Pain Med. 2018;43(7):756-762.
16. Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73(10):1244-1250.
17. Yao Y, Li H, He Q, Chen T, Wang Y, Zheng X. Efficacy of ultrasound-guided erector spinae plane block on postoperative quality of recovery and analgesia after modified radical mastectomy: randomized controlled trial. Reg Anesth Pain Med. 2019;rapm-2019-100983.
18. Hong B, Bang S, Chung W, Yoo S, Chung J, Kim S. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean J Pain. 2019;32(3):206-214.
19. Liu L, Ni XX, Zhang LW, Zhao K, Xie H, Zhu J. Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial. J Anesth. 2021;35(1):3-9.
20. Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med. 2019;7(8):174.
21. Jambotkar TC, Malde AD. A prospective study of the quality and duration of analgesia with 0.25% bupivacaine in ultrasound-guided erector spinae plane block for paediatric thoracotomy. Indian J Anaesth. 2021;65(3):229-233.
22. Hirai K, Usuda J. Uniportal video-assisted thoracic surgery reduced the occurrence of post-thoracotomy pain syndrome after lobectomy for lung cancer. J Thorac Dis. 2019;11(9):3896-3902.
23. Soultanis KM, Gonzalez-Rivas D. Devising the guidelines: The concept of uniportal video-assisted thoracoscopic surgery—incisions and anesthetic management. J Thorac Dis. 2019;11(Suppl 16):2053-2061.
24. Rocco G, Martucci N, La Manna C, Jones DR, De Luca G, La Rocca A, et al. Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg. 2013;96(2):434-438.