Comparative efficacy of erector spinae plane block versus surgeon-performed intraoperative intercostal nerve block in video-assisted thoracoscopic surgery: a retrospective analysis

Video-assisted thoracoscopic surgery (VATS) offers reduced postoperative pain and faster recovery, yet optimal analgesia remains essential. Regional anesthesia techniques, such as the erector spinae plane (ESP) block and intercostal nerve block (ICNB), are commonly employed. This study compares preoperative ESP block with surgeon-performed intraoperative ICNB in VATS patients.

In this retrospective study, 82 patients (≥ 18 years; ASA I-III) underwent elective VATS between January 2020 and December 2022 were analyzed. Forty patients received a postoperative ESP block and 42 an intraoperative ICNB. Primary outcomes included postoperative pain scores using the Visual Analog Scale, postoperative peak expiratory flow (PEF), postoperative IV opioid analgesic use, drainage time, and hospital length of stay.

Baseline demographics were similar. VAS scores were comparable at postoperative 1, 3, 6, 12 and 24 h. At postoperative 48 h, the ICNB group had significantly lower VAS scores (4.17 ± 1.03 vs. 4.78 ± 1.03; p = 0.00987). No significant differences were observed in postoperative iv opioid analgesic use, drainage time or hospital stay.

Both techniques provide effective early analgesia in VATS, with ICNB showing prolonged pain relief. Further prospective studies are warranted.