The use of ultrasound guided erector spinae plane block to optimize anesthetic regimen and improve patient satisfaction for open thoracic surgery: a randomized controlled clinical study

Background: The opioid-related side effects exist extensively and have significant adverse effects on patients’ recovery from general anesthesia and patient overall satisfaction after the thoracotomy. Recently, the erector spinae plane block (ESPB) has been reported to be used as a new effective analgesia for thoracic neuropathic pain. This randomized study was designed to assess whether ultrasound guided ESPB could effectively reduce the intraoperative consumption of opioids, improve the quality of recovery, reduce postoperative adverse events and improve patient satisfaction. Methods: Sixty patients undergoing open thoracic surgery were allocated randomly into the following 2 groups: Combined ultrasound guided ESPB and general anesthesia (GA) group (group EG, n = 30), and only GA group (group GA, n = 30). In group EG, before general anesthetic induction, the ultrasound guided ESPB was performed at the level of the T5 transverse process 3 cm from the midline. Then, 25 ml of 0.5% ropivacaine was injected deep to the erector spinae muscle. In both groups, the general anesthesia was inducted with 2 mg/kg of propofol, 0.3 ug/kg of sufentanil, 0.6 mg/kg rocuronium. Then, the general anesthesia was maintained by inhaling 2.5%-3.0% sevoflurane (1.3-1.5 MAC) and intermittent administration of sufentanil and rocuronium. The intraoperative consumption of sufentanil, recovery time, tracheal extubation time, dermatomal levels of sensory blockade by ESPB, pain score at 60 minutes after surgery, consumption of rescue analgesic tramadol, postoperative adverse events and patient satisfaction with anesthetic regimen during 48 hours after the thoracotomy were all recorded. Results: The cutaneous sensory block of ESPB was from T2 to T9. Compared with group GA, the intraoperative sufentanil consumption, pain score, tramadol consumption, incidence of nausea and vomiting were all significantly less in group EG (p < 0.05). In addition, the recovery time and tracheal extubation time were both significantly shorter in group EG compared to group GA (p < 0.001). And the patient satisfaction with anesthetic regimen in group EG was significantly higher compared to group GA (p < 0.001). Conclusions: Ultrasound guided ESPB combined with GA could significantly reduce intraoperative opioids consumption, provide a better recovery and improve patient satisfaction for open thoracotomy.