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Placebo versus Erector Spinae Plane Block for Medical Thoracoscopy Study (PAINLESS).

Bertin D Salguero1, Sung Choi2, Connor Smith3

  • 1Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA.

Respiration; International Review of Thoracic Diseases
|March 24, 2026
PubMed
Summary

The Erector Spinae Plane Block (ESPB) with bupivacaine did not significantly reduce post-medical thoracoscopy (MT) pain. Further research is needed on regional anesthesia for MT pain management, especially during pleurodesis.

Keywords:
Erector spinae plane blockInterventional pulmonologyPleural diseasePleuroscopyRegional anesthesiaThoracoscopy

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Area of Science:

  • Anesthesiology
  • Thoracic Surgery
  • Pain Management

Background:

  • Post-procedural pain is a common complication of medical thoracoscopy (MT).
  • Effective pain management is crucial for patient recovery and satisfaction after MT.
  • This study investigated the Erector Spinae Plane Block (ESPB) for post-MT pain relief.

Purpose of the Study:

  • To evaluate the efficacy of ESPB with bupivacaine in reducing post-medical thoracoscopy pain.
  • To compare pain scores, analgesic requirements, and quality of recovery between ESPB and placebo groups.
  • To determine if regional anesthesia can improve outcomes following MT.

Main Methods:

  • A prospective, triple-blind, randomized controlled trial was conducted.
  • Patients undergoing MT for pleural biopsy were randomized to receive either ESPB with bupivacaine or a placebo.
  • Pain was assessed using the Visual Analog Scale (VAS) and numerical rating scales; quality of recovery was measured using the QoR-15.

Main Results:

  • The study was terminated early due to lack of perceived clinical benefit and provider bias.
  • No significant difference in post-procedure VAS pain scores was found between the bupivacaine and placebo groups (p=0.890).
  • Secondary outcomes, including numerical pain scores, opioid use, and quality of recovery, also showed no significant differences between groups.

Conclusions:

  • ESPB with bupivacaine may not be effective in reducing post-MT pain.
  • The utility of regional anesthesia for intraprocedural or post-procedure analgesia during MT, particularly with pleurodesis, warrants further investigation.