Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2026.844770
Brazilian Journal of Anesthesiology
Original Investigation

Continuous erector spinae plane block for robotic-assisted thoracic surgery in lung cancer: a dual-center retrospective propensity-score weighted cohort study

Bloqueio contínuo do plano do músculo eretor da espinha para cirurgia torácica assistida por robô em câncer de pulmão: um estudo de coorte retrospectivo em dois centros ponderado pelo escore de propensão

Matheus Arraes, Sara Amaral, Saullo Queiroz Silveira, Leopoldo Muniz da Silva, Rafael Sousa Fava Nersessian, Francisco Jose Lucena Bezerra, Manoel de Souza Neto, Caroline Machado Nunes, Helidea de Oliveira Lima, Fernando Nardy Bellicieri, Glenio B. Mizubuti, Rafael Lombardi

http://dx.doi.org/10.1016/j.bjane.2026.844770 Braz J Anesthesiol, vol.76, n4, 844770, 2026
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Abstract

Background

Postoperative analgesia remains challenging in thoracic surgery, particularly with the rise of Robotic-Assisted Thoracoscopic Surgery (RATS). The Erector Spinae Plane Block (ESPB) is a promising opioid-sparing technique, but its role in RATS is unclear.

Methods

In this retrospective dual-center cohort study, we included 78 patients with lung cancer undergoing RATS, who received general anesthesia with or without ESPB. ESPB involved a single shot of 30 mL of 0.5% ropivacaine injection at T7, followed by a 24-hour infusion of 0.2% ropivacaine (7 mL.h⁻¹). The primary outcome was opioid rescue within 36 hours. Secondary outcomes included hospital length of stay and chest tube duration. Confounders were balanced with Inverse Probability Treatment Weighting (IPTW).

Results

In unadjusted analyses, there was no significant difference in rescue opioid consumption between groups (ESPB 37.8% vs. GA 27.3%; p = 0.46). After propensity score weighting to improve covariate balance, ESPB use was associated with lower postoperative opioid requirements (OR = 0.57; 95% CI 0.32–0.79; p = 0.01). This finding may reflect improved adjustment for measured confounders, although residual confounding cannot be excluded. In contrast, chest tube presence within 24 hours was associated with higher opioid requirements (OR = 2.32; 95% CI 1.22–4.20; p = 0.04). ESPB patients also required fewer scheduled opioids during the first 24–36h postoperatively (p = 0.03).

Conclusion

In this observational cohort, ESPB use was associated with lower postoperative opioid requirements in RATS. These findings suggest a potential role for ESPB within ERAS pathways, although randomized studies are needed to confirm efficacy and define its role in minimally invasive thoracic surgery.

Keywords

Analgesia; Erector spinae plane block; Lung neoplasms; Propensity score; Robotic surgical procedures; Thoracic surgical procedures

Resumo

Introdução

A analgesia pós-operatória continua sendo um desafio na cirurgia torácica, particularmente com o aumento da cirurgia torácica assistida por robô (RATS). O bloqueio do plano do músculo eretor da espinha (ESPB) é uma técnica promissora de poupança de opioides, mas seu papel na RATS não está claro.

Métodos

Neste estudo de coorte retrospectivo realizado em dois centros, incluímos 78 pacientes com câncer de pulmão submetidos à RATS, que receberam anestesia geral com ou sem ESPB. O ESPB envolveu uma injeção única (single shot) de 30 mL de ropivacaína a 0,5% em T7, seguida de uma infusão de 24 horas de ropivacaína a 0,2% (7 mL.h⁻¹). O desfecho primário foi o resgate de opioides em 36 horas. Os desfechos secundários incluíram o tempo de permanência hospitalar e a duração do dreno de tórax. Os fatores de confusão foram equilibrados com a Ponderação de Probabilidade Inversa de Tratamento (IPTW).

Resultados

Nas análises não ajustadas, não houve diferença significativa no consumo de opioides de resgate entre os grupos (ESPB 37,8% vs. AG 27,3%; p = 0,46). Após a ponderação pelo escore de propensão para melhorar o equilíbrio das covariáveis, o uso do ESPB foi associado a menores requisitos de opioides no pós-operatório (OR = 0,57; IC 95% 0,32–0,79; p = 0,01). Esse achado pode refletir um melhor ajuste para fatores de confusão mensurados, embora a confusão residual não possa ser excluída. Em contraste, a presença de dreno de tórax em 24 horas foi associada a maiores requisitos de opioides (OR = 2,32; IC 95% 1,22–4,20; p = 0,04). Os pacientes com ESPB também necessitaram de menos opioides prescritos regularmente durante as primeiras 24–36h de pós-operatório (p = 0,03).

Conclusão

Nesta coorte observacional, o uso de ESPB foi associado a menores requisitos de opioides pós-operatórios na RATS. Esses achados sugerem um papel potencial para o ESPB nos protocolos de recuperação otimizada após cirurgia (ERAS), embora estudos randomizados sejam necessários para confirmar a eficácia e definir seu papel na cirurgia torácica minimamente invasiva.

Palavras-chave

Analgesia; Bloqueio do plano do músculo eretor da espinha;  Neoplasias pulmonares; Escore de propensão; Procedimentos cirúrgicos robóticos; Procedimentos cirúrgicos torácicos

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Submitted date:
10/07/2025

Accepted date:
05/20/2026

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