A.P. Perkonos

Background. Lung resection procedures performed via a conventional thoracotomy are associated with substantial surgical trauma and pronounced postoperative pain. Providing adequate perioperative analgesia for such interventions remains a significant challenge for anesthesiologists. In thoracic surgery, the use of regional analgesia techniques is considered appropriate. The erector spinae plane (ESP) block is a relatively novel regional analgesia technique, the effectiveness of which — particularly in thoracic surgery — requires further investigation. The purpose is to evaluate the effectiveness of the ESP block for analgesia in lung resection surgery performed via a conventional thoracotomy, in comparison with thoracic epidural analgesia (TEA) and analgesia without regional techniques. Materials and methods. A prospective randomized controlled study was conducted involving 131 patients undergoing lung resection. They were randomly assigned to three groups: group A — TEA, group B — ESP block, and group C — no regional analgesia (controls). Pain intensity was assessed using the visual analog scale at rest and during deep inspiration; sleep quality was evaluated using a five-point scale over the first three postoperative days. Markers of stress response (glucose and cortisol) were measured intraoperatively and postoperatively, and cumulative postoperative morphine consumption was recorded. Results. Postoperative pain intensity was significantly lower in the TEA and ESP block groups compared to the control one. Levels of stress-response markers did not differ significantly between groups. Sleep quality was superior in the TEA group on the third postoperative day. Postoperative morphine requirements were lower in the TEA and ESP block groups than in the group without regional analgesia. Conclusions. The ESP block is an effective component of perioperative analgesia for thoracic surgery and may be considered an alternative regional analgesia technique in patients with contraindications to thoracic epidural analgesia.

Background. Pain syndrome due to thoracotomy is one of the most intense in surgery. Thoracic epidural anesthesia (TEA) is considered to be the “gold standard” of regional anesthesia for thoracic operations. Technical difficulties in applying this method can be a problem for the anesthesiologist. Goal of the study was to identify and analyze the difficulties associated with the use of TEA in thoracic surgery, to determine the percentage of effective use of TEA in the postoperative period. Materials and methods. Over a 10-month period, attempts to place an epidural catheter for analgesia of various thoracic operations were registered at the National Cancer Institute (a total of 204 patients during the observation period). During the study, the technical characteristics of the manipulation (level, patient position, duration of the procedure) were noted and the success of the attempts and the effectiveness of TEA for postoperative analgesia were evaluated, as well as the dependence of these results on the experience of the anesthesiologist performing the manipulation. Results. It was determined that out of 204 attempts to place an epidural catheter, 43 (21 %) were unsuccessful. The success of manipulation depended directly on the experience of the anesthesiologist who performed it: the lowest percentage of failures (9.3 %) was in doctors who had experience in thoracic surgery of more than 10 years, and the highest (35.9 %) was in residents. The effectiveness of postoperative analgesia in thoracic patients provided with TEA was also assessed — in 28 out of 161 patients (17.4 %), the analgesia was ineffective or insufficiently effective. The effectiveness of TEA in thoracic and gastric surgery did not differ significantly. The use of TEA was not associated with a large number of complications (6.4 %) and they were not life-threatening. Conclusions. TEA is a recognized effective method of regional anesthesia for thoracic operations, which is at the same time technically difficult to perform and has a fairly high failure rate. The success of TEA largely depends on the experience of the doctor performing the manipulation. Also, even in case of successful placement of an epidural catheter, TEA is not always effective.