Background and aims The erector spinae plane (ESP) block was described in 2016 by Forero et al. It involves the injection of local anesthetic into the interfascial plane, deep to erector spinae muscle (ESM), allowing the blockade of the dorsal and ventral rami of the thoracic spinal nerves. It was initially proposed for analgesia of costal fractures and pulmonary lobectomy.

The ESP block could probably be extended to a large number of surgical procedures.

We report two cases of thoracic surgery were the infectious state of the patient avoid the use of epidural catheter.

Methods Case report 1: An 18-year-old woman was submitted to VATS surgery for empyema. Anaesthetic plan was general anesthesia combined with a continuous ESP Block at the level of T8 (10 ml of L-Bupivacaine 0.25%) guided by ultrasound. Postoperative analgesia was achieved by continuous infusion + boluses of L-Bupivacaine 0.125%+Clonidine 0.75µg/ml through the catheter. Complementary analgesia was done with paracetamol and ketorolac.

Case report 2: a 60-year-old woman was submitted to VATS surgery for empyema. We applied the same protocol for the perioperative period (GA+ ESP block).

Results The average Numerical Rating Pain Scale was 3/10 in the postoperative period and no side effects were noticed. the catheter was removed on day 3.

Conclusions In cases of empyema, the ESP catheter seems to be a safe and effective alternative to epidural analgesia for VATS surgery. This block is easy to learn and we noticed no side effects (motor blockade, urinary retention, hypotension) or infectious complications regarding to epidural catheter.