Background and Aims We present a case series of five patients undergoing video-assisted thoracoscopic surgery for empyema. In this infectious state, we chose to perform a continuous ESP because of the relative contraindication of epidural catheter. We performed it to prevent and relieve the thoracic pain but also to limit the opioids consumption and their side effects in our frailty patients.
Methods The plan was general anaesthesia combined with a continuous unilateral ESP block. Postoperative analgesia was achieved by continuous infusion + bolus of L-Bupivacaine 0.125%. Complementary analgesia was done with paracetamol and when possible NSAID. Patients received iv doses of piritramide in the recovery room, but no patient-controlled analgesia or other intravenous opioids was administered subsequently.
Results Most of the patients maintained a Numeric pain Rating Scale (NRS) between 0 and 3.
We removed the catheters the same day than the pleural drains, usually at day 4. In the postoperative period, no side effects (motor blockade, urinary retention or hypotension) were noticed and patients attested high satisfaction scores. We emphasize the fact that none of them requested additional opioids.
Conclusions In cases of empyema, the ESP catheter combined with multimodal analgesia seems to be a safe and effective alternative to epidural analgesia for VATS surgery. This technique, easy to perform, allows an early mobilization of the patient regarding the low pain scores and the absence of side effects. Prospective randomized trials are needed to confirm the benefits of the ESPB compared to epidural or paravertebral bloc.
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