Erector Spinae Plane Block for Postoperative Analgesia Management Following Video Assisted Thoracic Surgery
Condition: Lung Cancer
Study type: Interventional

Summary: 
      Video assisted thoracic surgery (VATS) has recently been evaluated as the standard surgical
      procedure for lung surgery. Although VATS is less painful than thoracotomy, patients may feel
      severe pain during the first hours at postoperative period. Analgesia management is very
      important for these patients in postoperative period since insufficient analgesia can cause
      pulmonary complications such as atelectasis, pneumonia and increased oxygen consumption. The
      ultrasound (US) guided erector spina plane (ESP) block is a novel interfacial plan block
      defined by Forero et al. at 2016. ESP block provides thoracic analgesia at T5 level and
      abdominal analgesia at T7-9 level. Visualization of sonoanatomy with US is easy, and the
      spread of local anesthesic agents can be easily seen under the erector spinae muscle. Thus,
      analgesia occurs in several dermatomes with cephalad-caudad way. In the literature, there is
      not still any randomized study evaluating ESP block efficiency for postoperative analgesia
      management after VATS. The aim of this study is to evaluate US-guided ESP block for
      postoperative analgesia management after VATS.
    

Detailed description: 
      Postoperative pain after thoracic surgery which is attributed to muscle incision, rib
      retraction, and intercostal nerve damage may be severe such a degree that it may cause
      pulmonary complications such as atelectasis, pneumonia and increased oxygen consumption.
      Because video assisted thoracic surgery (VATS) has some advantages over open thoracotomy such
      as reduced pain, shoulder dysfunction, early pulmonary impairment, rapid recovery, short
      hospital stay and low complication risk, it has recently been evaluated as the standard
      surgical procedure for lung surgery. Although VATS is a less painful procedure than open
      thoracotomy, patients may still feel severe pain during the first hours at postoperative
      period. As thoracic epidural analgesia (TEA) is the gold standard analgesic technique after
      thoracotomy, it is also being used for analgesia management following VATS. Hence TEA has
      some difficulties in administration and side effects, minimally invasive analgesic techniques
      are supported for pain management in patients who underwent VATS. The gold standard minimal
      invasive analgesic technique for VATS is still be questioned. Thoracic paravertebral block
      (TPVB) has been evaluated as the first step regional analgesia technique after VATS. However,
      its administration is difficult because of its anatomical proximity to important structures
      such as the pleura and central neuro-axial system. Therefore it may cause complications such
      as pneumothorax and neuro-axial injury. The ultrasound (US) guided erector spina plane block
      (ESPB) - a novel interfacial plan block defined by Forero et al. in 2016 - has the advantage
      of being away from the pleural and neurological structures, thus the risk of complications is
      lower. In the literature, case reports about the analgesic effect of ESPB after thoracotomy
      and VATS has been increasing. However there is no randomized study for VATS yet. In this
      study, investigators aimed to evaluate the efficacy of US-guided ESPB for postoperative
      analgesia management following VATS.
    

Intervention name(s): Erector spinae plane block
Intervention type(s): Other
Intervention description(s): Erector spinae plane block was performed to the patients under aseptic conditions
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: randomized prospective study
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Erector spinae plane block; Video assisted thoracic surgery; Postoperative analgesia