Ultrasound Guided Parascapular Sub-Iliocostalis Plane Block versus Thoracic Epidural for Postoperative Analgesia in Thoracotomy Operations

Abstract

Background: Post-thoracotomy pain syndrome (PTPS) is a significant clinical problem affecting patient recovery and quality of life.  Effective postoperative pain management is crucial in reducing the incidence of PTPS. Both parascapular sub-iliocostalis plane (PSIP)  block and thoracic epidural analgesia (TEA) are employed to manage post-thoracotomy pain, but their efficacy and safety profiles need  thorough comparative analysis.

Objective: In order to reduce the occurrence of PTPS, compare the safety and efficacy of ultrasound- guided PSIP block to TEA for postoperative analgesia in patients following elective thoracotomy.

Patients and methods: This  randomised, single-blind clinical study was undertaken at Benha University Hospital. A randomised comparison was conducted between  two groups of 52 adult patients undergoing elective thoracotomy: one group received PSIP block, and the other group received TEA. The  incidence of adverse effects, visual analogue scale (VAS) pain scores, morphine use, and hemodynamic parameters were evaluated for  both groups.

Results: The study enrolled 52 patients with no significant differences in demographic characteristics between the groups  (p>0.05). The TEA group demonstrated significantly lower morphine consumption in the first 48 hours postoperatively (p<0.001),  indicating superior analgesic efficacy. However, patients in the TEA group experienced higher incidences of hypotension (p<0.001) and  did not differ significantly in pain scores across most time points  (p>0.05). The PSIP group had a shorter ICU stay (mean 1.31 days versus  2.00 days, p<0.001).

Conclusion: While TEA provides superior analgesia reflected in lower morphine consumption, PSIP block is  associated with fewer hemodynamic complications and shorter ICU stays, suggesting an advantageous profile for enhancing recovery  after thoracotomy.