2026 FSA Podium and Poster Abstracts

Introduction/Background: Effective postoperative analgesia is critical in minimally invasive thoracic surgery as inadequate pain control can lead to pulmonary complications, adverse cardiac events, increased risk of developing chronic pain syndromes, and overall slower recovery (1). Neuraxial anesthesia is well established as an effective modality for postoperative analgesia, though its utility can be complicated in patients requiring systemic anticoagulation (2). Compared with neuraxial techniques, erector spinae plane (ESP) blocks and continuous ESP catheters carry lower risks of developing neuraxial or deep tissue hematomas. ESP blocks have demonstrated comparable postoperative analgesia when compared to neuraxial techniques. (3). This case report details the use of a continuous ESP catheter for postoperative pain control in an anticoagulated trauma patient undergoing minimally invasive thoracic surgery. This case adds to the growing body of literature on safe and effective analgesic options in this high-risk patient population.

Methods: A 60-year-old male with a past medical history of paroxysmal atrial fibrillation on eliquis, presented to the hospital after a mechanical ground level fall. He was found to have right sided 4th-5th rib fractures with a right hemothorax. On day 12, a chest x-ray was obtained for worsening respiratory status, new-onset fever, and leukocytosis. Imaging revealed a persistent right pleural effusion. A decision was made to perform a video-assisted thoracoscopic surgery (VATS) for suspected empyema. The acute pain service was consulted post operative analgesia. Intraoperatively, a primary ESP block was performed at the T5 level under ultrasound guidance with initial bolus of 0.5% ropivacaine. Subsequently a 20G catheter was placed and a 0.125% bupivacaine infusion was initiated. Postoperative pain scores, opioid consumption, and respiratory status were monitored.

Results: On post-operative day (POD) 1, the patient was extubated to High Flow Nasal Cannula (HFNC) requiring 30 MME that day. On POD 2,  he required zero opioid medication and was weaned to nasal cannula on POD 3. On POD 4, the ESP catheter was removed, and he was downgraded from the SICU. The patient experienced no complications while the catheter was in place.

Discussion/Conclusion: Although the efficacy of neuraxial techniques is well established, their use in anticoagulated patients can be limited due to concern for noncompressible bleeding.  The ESP block is performed in a more superficial and compressible tissue plane, making it a safer option.The ESP catheter facilitated improved respiratory mechanics and participation in pulmonary hygiene. As seen with this patient, the ESP catheter also provided a total opioid dose reduction.

Although this report is limited by the discussion of a single-patient and short follow-up, it contributes to the growing evidence supporting ESP catheters as a useful analgesic option in anticoagulated patients. In conclusion, continuous analgesia provided by an ESP catheter may offer a safe and effective alternative to neuraxial techniques for postoperative pain control in anticoagulated patients with rib fractures or undergoing minimally invasive thoracic surgery. Further studies are needed to define optimal dosing regimens, duration of catheter use, and comparative effectiveness relative to traditional regional techniques in high-risk populations.