Abstract

Background and objective
Medical thoracoscopy (MT) is associated with significant postoperative pain of varying intensity and duration, leading to significant morbidity. Our study compared the efficacy of thoracic spinal anesthesia (TSA) combined with erector spinae plane block (ESPB) with conscious sedation for MT using a patient-centered outcome measure.

Methods
This is a non-randomized prospective comparative pilot study wherein 36 patients undergoing MT were assigned alternately to receive TSA with ESPB or conscious sedation. Conscious sedation was administered with fentanyl and midazolam in graded doses with local instillation of lignocaine 2%. TSA was administered at the T6-T7 level with 25 mcg of fentanyl and 0.5% levobupivacaine (1.5 ml), followed by ESPB with 0.25% levobupivacaine (10 ml). The primary outcome was to compare the efficacy of ESPB with conscious sedation in terms of quality of recovery. The secondary outcome was to compare the time to administration of the first analgesic post procedure, total postoperative opioid consumption (mg) at 24 hours, and duration of the procedure. Intraoperative hemodynamic stability and block-related and post-procedure complications were also assessed.

Results
The total Quality of Recovery-15 (QoR-15) score was 112.83 ± 27.16 vs. 65.78 ± 22.13 (p = 0.0001), time to first analgesic was 11.69 ± 6.93 hours vs. 2.39 ± 1.69 hours (p = 0.0001), opioid consumption was 50 ± 10 vs. 75 ± 15 (p = 0.001), and the mean duration of the procedure was 64.72 vs. 93.89 minutes (p = 0.0001) in the ESPB group and the conscious sedation group, respectively. No block/anesthesia-related complications were reported in either group.

Conclusion
The combination of TSA with ESPB can be a novel, effective, and safe anesthetic technique for MT, offering better quality of recovery, improved postoperative analgesia, shorter procedure duration, and reduced perioperative morbidity.