Regional erector spinae block for medical thoracoscopy.
No Thumbnail Available
Authors
Aujayeb, Avinash
Blundell, Michael
Halvey, Edward
McPherson, J.
Issue Date
2022
Type
Conference Abstract
Language
en
Keywords
nerve block , medical thoracoscopy
Alternative Title
Abstract
Introduction: Medical thoracoscopy (MT) is an invasive procedure, performed under local anaesthetic and sedation. Intra and post procedural discomfort can be significant. Erector spinae plane (ESP) blocks are a regional anaesthetic technique used for pain relief in thoracic procedures. Our centre has recently begun using ESP blocks pre-procedure for post operative analgesia for day case MT, and a service evaluation project examined patient satisfaction and pain outcomes.
Methods: 9 patients undergoing MT from Sept 2021 to Feb 2022 were included. Peri- and post-operative opioid use and depth of required sedation was recorded. Pain scores during procedure, in recovery and at home were recorded by retrospective interview and review of recovery charts, and a functional pain questionnaire was administered via telephone.
Results: The average greatest depth of sedation required using propofol target controlled infusion was 1.92 (standard error of mean [SEM] 0.27), with remifentanil 2.52 (SEM 0.46). 78% of patients required oral analgesia on day 0 post discharge. 55% of patients required oral analgesia on post-op day 1. Patients used an average of 3.33 mg oral morphine (SEM 2.35) in hospital, and 3 mg (SEM 2) on post-op day 1. Periprocedural pain scores were 0.66 (SEM 0.27). Pain scores in recovery were 1.56 (SEM 0.76). Pain scores 3–12 hours post discharge were 3.56 (SEM 0.7), while pain scores on post-op day 1 were significantly higher at 5.56 (SEM 0.90) (figure 1).
Functional pain scoring showed that overall patients were able to tolerate activities of daily living well on discharge and reported a good ability to breathe & cough, but felt less able to perform activities such as light housework or heavier exercise (figure 2). There was a non-significant trend towards greater levels of function overall on post-op day 0 than on day 1. 100% of patients felt that overall their pain was well controlled on the day of the procedure and after returning home. No complications of block were reported. Discussion ESP blocks provide good peri-procedural analgesia for MT. Pain scores were in keeping with a significant analgesic effect lasting several hours then wearing off.
The project showed pain outcomes and patient acceptability were good for the use of regional anaesthesia for MT. A formal randomised controlled trial is now planned.
Description
Citation
McPherson, J., Halvey, E., Blundell, M. and Aujayeb, A. (2022) P127?Regional erector spinae block for medical thoracoscopy. Thorax; 77 : A149-A150.
Publisher
License
Journal
Thorax
Volume
Issue
PubMed ID
ISSN
1468-3296