Comparison of three locoregional anesthesia techniques for the postoperative pain management after pneumothorax surgery: erector spinae plane block, serratus anterior plane block and intrathecal morphine injection ; Comparaison de trois techniques d’anesthésie locorégionale sur la gestion de la douleur après chirurgie du pneumothorax : bloc des érecteurs du rachis, bloc du serratus et rachianalgésie

Introduction: surgery for primary spontaneous pneumothorax is performed by videothoracoscopy (VATS) and consists mainly of pleurectomy. To date, there is no recommendation on pain management and specifically regarding locoregional anesthesia in this indication. Thus, the aim of our study is to evaluate the analgesic efficacy of different techniques in pain management after pneumothorax surgery.Material and method: our study is a prospective monocentric observational cohort performed between March 2020 and June 2021, in patients undergoing VATS for spontaneous pneumothorax. Before incision, was performed an erector spinae plane block (ESPB), a serratus anterior block (SAP) or intrathecal morphine injection (ITM). The primary endpoint was the cumulative oral morphine consumption during the 3 postoperative days. Statistical analysis used univariate models, survival curve description, and logistic regression to test the association between variables.Results: 46 patients were included with 11 in the SAP group, 13 in the ITM group and 22 in the ESPB group. The cumulative dose of morphine was not significantly different between groups (22.5 [5.00; 42.5], 5.00 [0; 15.0], 15.0 [7.50; 22]; p=0.39). ITM was associated with a reduction in morphine requirements during the first postoperative 24h (OR 0.09 [0.01-0.40], p=0.005). Survival curve analysis showed a longer delay for the first morphine intake when ITM is performed versus ESPB and SAP (p=0.016).Conclusion: this study suggests that spinal analgesia seems to be beneficial during the first postoperative 24 hours but no technique was more effective in terms of overall morphine consumption. More studies are needed to refine the choice of the technique for pain management after pneumothorax surgery. ; Introduction : la chirurgie du pneumothorax spontané primaire est réalisée par vidéothoracoscopie (VATS) et consiste principalement en une pleurectomie. Á ce jour, il n’existe pas de recommandation sur la gestion de la douleur et notamment l’anesthésie locorégionale (ALR) ...