A prospective double-blinded randomized control trial comparing erector spinae plane block to thoracic epidural analgesia for postoperative pain in video-assisted thoracic surgery

Saudi Med J. 2023 Feb;44(2):155-163. doi: 10.15537/smj.2023.44.2.20220644.


Objectives: To compare the analgesic efficacies of erector spinae plane (ESP) block and thoracic epidural analgesia (TEA) in video-assisted thoracic surgery (VATS).

Methods: Sixty patients undergoing VATS received patient-controlled TEA with a basal rate of 3 ml/hour (h), a bolus of 3 ml (Group E), or ESP block with programmed intermittent bolus infusions of 15 mL/3 h and a bolus of 5 ml (Group ES) for 2 postoperative days. The primary outcome was to compare pain scores at rest 24 h postoperatively between the 2 groups. Secondary outcomes included NRS score for 48 h, procedural time, dermatomal spread, use of rescue medication, adverse events, and patient satisfaction.

Results: Patients with continuous ESP block had a higher NRS score than those with TEA but no statistical difference at a specific time. The dermatomal spread was more extensive in the TEA group than in the ESP block group (p=0.016); cumulative morphine consumption was higher in the ESP block group (p=0.047). The incidence of overall adverse events in the TEA group was higher than in the ESP block group (p=0.045).

Conclusion: Erector spinae plane block may be inferior to TEA for analgesia following VATS, but it could have tolerable analgesia and a better side effect profile than TEA. Therefore, it could be an alternative to TEA as a component of multimodal analgesia.

Keywords: epidural analgesia; erector spinae plane block; morphine; multimodal analgesia; pain; patient-controlled analgesia; postoperative; programmed intermittent bolus infusion; thoracic surgery; video-assisted.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Analgesia, Epidural*
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Local / therapeutic use
  • Humans
  • Nerve Block*
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control
  • Prospective Studies
  • Thoracic Surgery, Video-Assisted / adverse effects
  • Ultrasonography, Interventional


  • Anesthetics, Local
  • Analgesics, Opioid