Comparison of the Methods Used for Pain Management After Posterolateral Thoracotomy

Background: Acute postoperative pain remains a significant concern in lung surgery, as it may contribute to morbidity through impaired ventilation. Multimodal analgesia is commonly applied in patients undergoing thoracotomy, and regional anesthesia techniques have gained popularity for postoperative pain control in recent years. While the current evidence is still limited, erector spinae plane (ESPB) block and serratus anterior plane block (SAPB) are considered clinically safe options. However, comparative data regarding the effectiveness of ESPB, SAPB, and intercostal nerve block (ICNB) following open thoracotomy are scarce. Methods: This study aimed to compare postoperative pain scores, opioid and additional analgesic consumption, postoperative complications, and hospital stay between ultrasound-guided ESPB, SAPB, and ICNB in patients undergoing posterolateral thoracotomy. Results: Resting and coughing pain scores were lower in the SAPB and ESPB groups compared with the ICNB group at all postoperative time points (p < 0.05). Additional analgesic consumption was higher in the ICNB group (p < 0.05). ESPB was associated with lower pain scores than SAPB at the first postoperative hour (p = 0.014). Furthermore, the proportion of patients requiring additional analgesics was higher in the SAPB group compared with the ESPB group (p = 0.001). Conclusions: Fascial plane blocks (ESPB and SAPB) were associated with more favorable pain outcomes compared with ICNB in the early postoperative period. Within the fascial plane techniques, ESPB demonstrated lower pain scores at the first postoperative hour and reduced need for additional analgesics compared with SAPB. These findings suggest a potential benefit of ESPB, although further studies with larger populations are warranted to confirm these results. Trial registration: Retrospectively registered