Background and aims Thoracic epidural analgesia is currently the first line technique for use in managing perioperative pain follow thoracotomy. However continuous erector spinae plane (ESP) block is growing in popularity because of its simplicity, safe and lesser side effects.

We aim to present the result of the analgesic efficacy of continuous ultrasound-guided ESP block in two cases of thoracotomy surgery.

Methods 65-year-old woman presented for right inferior lobectomy (adenocarcinoma) and a 49-year-old woman, presented for left superior lobectomy (adenocarcinoma). Balanced general anesthesia more continuous ESP was performed.

Before induction, the ultrasound-guided unilateral continuous ESP block was performed at the level of T5. 30 milliliters of ropivacaine

0,375% were administered primarily and 10 millimeters before start of surgery.

The multimodal approach for postoperative analgesia was: programmed intermittent mandatory boluses through the ESP catheter of ropivacaine 0,2% 8 ml/h + paracetamol 1 g 8/8h + ketorolac 30 mg 12/12h. Rescue analgesia with tramadol 100 mg.

Results Both patients did not need extra boluses; greatest pain was 4 (numeric scale), at 3 and 5 hours after surgery. They both do tramadol 100 mg. Beside this they did not require more analgesia until the 48 hours with pain <3.

Conclusions Pain after thoracotomy surgery can be difficult to control with a multimodal analgesia with vast side effects and, thoracic epidural catheter with also its potential complications. Recently, ESP block has increased acceptance because is a securely thoracic paravertebral block and with lower complications. Continuous ESP block provides effective post-operative analgesia follow thoracotomy with excellent pain control inside multimodal analgesic program with few opioids needs.