Discussion
lung cancer, cardiac arrhythmias, ESPB, cardiotoxicity
LUNG CANCER, CARDIAC ARRHYTHMIAS, RECRUITMENT, COMPLICATIONS
This study of postoperative analgesia for VATS lung cancer resection, comparing continuous ultrasound-guided ESPB versus ICNB, is the first of its kind in Slovenia. Due to the Covid-19 pandemic crisis, causing limited resources and additional healthcare concerns, the time of patient recruitment was prolonged, and only 60 patients from 200 were eligible for our study in a two-year period. The most significant findings were lower opioid demands in the ESPB group (21.64 ± 14.22 mg In recent years, some studies were comparing single-shot ICNB and ESPB with unclear advantages. In terms of postoperative opioid use, the ICNB was reported by some studies to be more efficient and by other studies to be less efficient than the ESPB.Our results are consistent with Fiorelli The mean piritramide use between the groups started to differentiate after 12 hours postoperatively, marking the time when the ICNB effect wears out. Other observed parameters, such as time to chest tube removal, hospital discharge, and complications were similar in both groups. However, continuous ESPB is more demanding from the catheter insertion procedure to regular post-operative observations.Despite the continuous neuromuscular block of the hemi-thoracic musculature, the ability to fully perform respiratory physiotherapy was not compromised by the continuous ESPB. MIP and MEP measurements decreased substantially but did not differ significantly between the two groups after 24 hours or after 48 hours. Because the absolute MIP and MEP results vary strongly in literature, we included relative values with the patients’ pre-operative measurements as the baseline.As common complications after lung resection, cardiac arrhythmias were monitored.Comparing ESPB to a placebo without regional anesthesia would be unethical considering the benefits of regional truncal blocks that have already been proven.The main limitation of the study is the inability to double-blind the analgesic method because of the catheter. The second limitation is the number of included patients. It would be reasonable to conduct another study on a larger scale to see whether any other inter-group differences appear. The third limitation is the protocol for the continuous ESPB, which is subject to future changes regarding local anesthetic selection and administered volume. Ropivacaine is currently the best local anesthetic of choice because of its large safety profile and the lowest potential risk for cardiotoxicity