Effect of Preoperative and Postoperative Erector Spinae Plane Block on Perioperative Hemodynamics and Postoperative Analgesia in Video-assisted Thoracoscopic Surgery: A Randomized Controlled Study

Objectives: To compare the hemodynamic and analgesic effects of pre-/postoperative erector spinae plane block (ESPB) application in patients undergoing video-assisted thoracoscopic surgery (VATS).
Methods: This was a prospective, randomized multicenter study. Patients were assigned to preoperative ESPB (Group-Pre; n=32) or postoperative ESPB (Group-Post; n=33) groups. Ultrasound-guided block applications were performed under general anesthesia with single-needle insertion. Pain scores were assessed by visual analog scale (VAS). Demographic characteristics and surgical procedure data of the patients were recorded. In addition, perioperative mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), heart rate (HR), and bispectral index (BIS) values were recorded. MAP, SpO2, HR, VAS scores (while resting/coughing), additional analgesic use, morphine consumption, and side effects were recorded 24 hours postoperatively.
Results: The groups were statistically similar in terms of MAP, HR, and SpO2 in the intraoperative and postoperative periods. VAS resting and coughing values were statistically significantly higher at the 1st, 2nd, 4th, and 12th hours in Group-Post compared with Group-Pre (p<0.05). There was no statistically significant difference between the groups in terms of 24-hour VAS at rest (p=0.258) or VAS at cough (p=0.189). The amount of remifentanil requirement, morphine consumption, and additional analgesic use in Group-Post was statistically significantly higher than in Group-Pre (p<0.05).
Conclusion: ESPB applied in the preoperative period is more effective in suppressing the surgical response in VATS, as it limits intraoperative opioid consumption and provides more effective analgesia in the postoperative period.