Abstract
BACKGROUND: Erector spinae plane blocks (ESPB), a new and increasingly popular technique for controlling thoracic pain, have typically been performed around the T5 level. Using a T1 ESPB for first rib resections in patients with thoracic outlet syndrome (TOS) might offer better pain control relative to the current standard of intravenous multimodal pain management alone. METHODS: All first rib resections for patients with TOS during an 18-month period (n = 380) were analyzed. In-hospital opioid consumption, the number of patients discharged with an opioid prescription, and hospital admission length were compared between patients receiving ESPBs and multimodal pain management alone. RESULTS: ESPB patients received 26.18% less morphine milligram equivalents on postoperative day 1 (P < 0.001) and were 13.23% less likely to be discharged with an opioid prescription (P < 0.001). Admission length between the two groups was not meaningfully different (P = 0.84). CONCLUSION: T1 ESPBs offer effective regional pain control for TOS patients undergoing first rib resections while mitigating the potential for opioid dependence and abuse. No increased risk of complication with ESPB was observed relative to multimodal pain management alone.