The erector spinae plane block is not superior to perioperative systemic lidocaine infusion for postoperative analgesia management after thoracotomy: a randomized double-blind study.

Background: The effect of erector spinae plane block and systemic lidocaine infusion for major thoracotomy is still unclear. Therefore, we aimed to compare ESPB, systemic lidocaine and standard analgesia in patients who undergoing major thoracotomy.

Methods: Patients with ASA I-III, aged between 18 and 65 years scheduled for major thoracotomy were enrolled. Patients were randomly assigned to receive an intravenous (IV) infusion of placebo combined with ESP block using placebo (group P), ESP block with 0.25% bupivacaine combined with IV placebo (group ESPB), or IV-lidocaine combined with ESP-block using placebo (group L). The primary outcome was postoperative (24 h) total opioid consumption. The secondary outcomes were VAS scores, rescue analgesia, and intraoperative remifentanil consumption.

Results: Resting VAS scores were significantly lower in both groups ESPB and L compared to group P during the first four postoperative hours. Similarly, dynamic VAS scores were lower in group ESPB and group L compared to group P during the first two postoperative hours (p < 0.05). ESP block was not found to be superior to systemic lidocaine in reducing morphine requirements during the first 24 h (30.25 ± 5.1 vs. 28.7 ± 3.1 respectively, p = 0.567). Additionally, the difference in morphine consumption between group P and either ESP-block or systemic lidocaine groups was minimal, amounting to only 3-4.5 mg. However, the requirement for rescue analgesia was significantly lower in both groups ESPB and L compared to group P (p < 0.05). There was no difference between groups ESPB and L in terms of rescue analgesia requirement.

Conclusion: ESP block did not demonstrate superior postoperative analgesic efficacy compared to systemic lidocaine in patients undergoing major thoracotomy.