Effect of ultrasound-guided erector spinae plane block for preoperative CT-guided percutaneous localization of pulmonary nodules: a randomized controlled trial.

BACKGROUND

The increasing detection of pulmonary nodules through low-dose computed tomography screening has necessitated precise preoperative localization techniques. While local anesthesia is routinely used for CT-guided pulmonary nodule localization, it inadequately addresses deep tissue pain during pleural penetration. This study is to evaluate the analgesic efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) during CT-guided pulmonary nodule localization.

METHODS

This single-center, prospective, randomized controlled trial was conducted from June 2024 to January 2025, enrolling 82 patients undergoing preoperative CT-guided pulmonary nodule localization. Participants were randomly assigned to either control group (local anesthesia with 4 ml 1% lidocaine) or ESPB group (ultrasound-guided ESPB with 20 ml 0.375% ropivacaine plus local anesthesia). The primary outcome was numerical rating scale (NRS) score during pleural penetration. Secondary outcomes included anxiety levels, radiation exposure, procedural time, hemodynamic parameters, pneumothorax incidence, and patient satisfaction. Statistical analysis was performed using independent-sample t-test and Mann-Whitney U test.

RESULTS

The ESPB group demonstrated significantly lower NRS scores during pleural penetration compared to the control group (2.68 ± 1.52 vs. 5.17 ± 1.32). Patients receiving ESPB exhibited reduced preoperative anxiety (44.71 ± 3.45 vs. 50.63 ± 3.74), decreased radiation exposure (401.06 ± 266.01 vs. 875.36 ± 377.45 mGy*cm), shorter fluoroscopy time (55.10 ± 10.54 vs. 117.39 ± 20.68 s, ), and lower pneumothorax incidence (4.88% vs. 19.51%), all P < 0.05. Post-procedural comfort scores and patient satisfaction were significantly higher in the ESPB group.

CONCLUSIONS

Ultrasound-guided ESPB improves analgesia, reduces anxiety, radiation exposure and complications while enhancing patient satisfaction during CT-guided pulmonary nodule localization, representing a valuable adjunct for thoracic interventional procedures.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06441071, registered May 8, 2024.