Comparison of methods used for pain management after thoracotomy

OBJECTIVE: It was aimed to compare postoperative pain scores, opioid and additional analgesic consumption, postoperative complications, and duration of hospital stay between the USG guided erector spina plan (ESPB) block, serratus anterior plane block (SAPB) and the intercostal block (ICNB) performed by the surgical team in posterolateral thoracotomy operations in this study. MATERIALS AND METHODS: Our study was approved by Hacettepe University Non-Interventional Clinical Research Ethics Committee. The approval date and number were 17.12.2019 and 2019/29-10. Our study was carried out in Hacettepe University Anesthesiology and Reanimation Clinic through examining the records of patients who had an elective posterolateral thoracotomy by the Department of Thoracic Surgery between October 2019 and June 2021. The patients aged 18 years and older, ASA score 0.05). The VAS scores at rest and during coughing showed a statistically significant difference between the three groups at all postoperative hours (p<0.05). The pain scores of Group 1 (SAPB group) and group 3 (ICNB group) showed a significant difference in all post-op hours (p<0.05). In addition, the difference in pain scores between group 2 (ESPB group) and group 3 (ICNB group) was also statistically significant at all hours (p<0.05). There was a significant difference between the pain scores of Group 1 and group 2 at the postoperative 1st hour (p=0.014). On the other hand, the difference in pain scores between group 1 and group 2 was not statistically significant in the other hours (p>0.05). There was no statistically significant difference between the three groups in terms of the morphine doses taken during the 24 hours postoperatively (p>0.05). Considering the number of PCA trials of the groups, there was a statistically significant difference between group 2 and group 3 at the 4th and 6th hours. Additional analgesic consumption was higher in group 3 compared to both group 1 and group 2 (p=0.034, p<0.001). The number of patients using additional analgesics was higher in group 1 compared to group 2. There was no significant difference between the three groups in terms of postoperative heart rate, mean arterial pressure, and SpO2 values. Group 2 had the lowest atelectasis rate while group 3 had the highest rate among all groups. CONCLUSION: It was found that the erector spinae plane block and serratus anterior plane block decreased the VAS scores, reduced additional analgesic consumption, and reduced the rate of postoperative atelectasis comparing with the intercostal nerve block in the patients who underwent thoracotomy. When comparing the fascial area blocks within themselves, it was observed that there was no significant difference between the VAS scores of the ESPB and SAPB groups. However, the ESPB showed a superiority over the SAPB in terms of consumption of additional analgesics and development of postoperative atelectasis. Keywords: Thoracotomy, Erector Spinae Plane Block, Serratus Anterior Plane Block, Intercostal Nerve Block, Post-thoracotomy Pain