Erector Spinae Plane Block for Thoracoscopic Surgeries: A Single-center Retrospective Investigation into Patient-controlled Analgesia and Pain

Erector spinae plane blocks are increasingly incorporated into thoracic surgical analgesia practices, yet evidence regarding its effect on postoperative opioid requirements following video-assisted thoracoscopic surgery remains mixed. The objective of this study was to evaluate whether erector spinae plane blocks reduce postoperative opioid consumption without differences in patient-reported pain scores in patients undergoing video-assisted thoracoscopic surgery. We conducted a retrospective single-center cohort study at a tertiary academic hospital including adult patients who underwent video-assisted thoracoscopic surgery between October 2021 and October 2024. Procedures included lobectomy, wedge resection, and other pulmonary or pleural operations; patients with chronic pain, opioid dependence, conversion to thoracotomy, or incomplete data were excluded. Erector spinae plane blocks were performed at the discretion of the attending anesthesiologist using bupivacaine or ropivacaine, and all patients received multimodal analgesia with postoperative patient-controlled analgesia. Primary outcomes were patient-controlled analgesia morphine milligram equivalents and total postoperative morphine milligram equivalents. Secondary outcomes included pain scores at 0, 12, and 24 hours, adjunct analgesic use, and hospital and post-anesthesia care unit length of stay. Among 418 patients, erector spinae plane blocks were associated with lower patient-controlled analgesia morphine milligram equivalents (17 vs 24, p 0.001) and lower total postoperative morphine milligram equivalents (33 vs 43, p 0.001), without differences in pain scores, adjunct analgesic use, or length of stay. Multivariable linear regression confirmed independent reductions of 3.5 morphine milligram equivalents for patient-controlled analgesia use and 7.5 morphine milligram equivalents for total postoperative opioid consumption. Erector spinae plane blocks were associated with statistically significant reductions in postoperative opioid requirements without differences in patient-reported pain scores. The magnitude and clinical relevance of this reduction require further evaluation in prospective randomized trials.