VATS lobectomy with opioid free anesthesia using erector spinae plane block versus standard anesthesia: a randomized controlled study
Meliha Orhon Ergün, Ecem Güçlü, Seniyye Ülgen Zengin
Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Istanbul, Turkey
Giriş: Opioid-free anesthesia with erector spinae plane block (ESPB) has the potential to decrease perioperative opioid need thereby potentially reducing related complications. This study aimed to compare opioid-free anesthesia with ESPB and standard anesthesia with the use of opioid, in patients undergoing video-assisted thoracic surgery (VATS), in terms of postoperative opioid need -through patient control analgesia- as well as postoperative pain management, recovery quality, and opioid-related side effects.
Gereç ve Yöntem: Seventy-four patients who underwent lobectomy with VATS were included in this randomized-controlled study. Opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. Opioid group received standard anesthesia with opioid use. Groups were compared for postoperative morphine requirement as well as postoperative pain as measured by visual analogue scale (VAS), intraoperative vital parameters, recovery quality using Quality of recovery-40 questionnaire, and opioid-related complications.
Bulgular: Opioid-free group received significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3±3.4 vs. 21.7±7.9 mg, p<0.001). In addition, opioid-free group had significantly better postoperative pain scores and QoR-40 scores (184.3±7.5 versus 171.2±6.4, p<0.001), shorter times to mobilization (5.5±0.8 versus 8.1±1.1 hours, p<0.001) and oral intake (5.8±0.6 versus 6.4±0.6 hours, p<0.001), as well as less frequent opioid-related side effects.
Tartışma ve Sonuç: Findings of this study suggest that opioid-free anesthesia with ESPB represents a promising option for patients undergoing lobectomy with VATS. It has the potential to decrease postoperative opioid need, improve postoperative pain management, and reduce opioid-related unwanted consequences
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