Table 3. Summary of regional anesthesia options for thoracic surgery with target of each block, intended clinical effect, and considerations for use in thoracotomy and thoracoscopy surgical approaches.

Regional anesthesia	Nerves affected	Expected effect	Thoracotomy	Thoracoscopy
Thoracic epidural analgesia	Bilateral spinal nerves (includes dorsal ramus, ventral ramus/ intercostal nerve, and visceral fibers/sympathetic chain)	Multi-level bilateral segmental somatic and visceral block, sympathectomy	Consider unless contraindicated	Likely not necessary/ advantageous over other regional approaches
Paravertebral block	Ipsilateral spinal nerve (includes dorsal ramus, ventral ramus/intercostal nerve, and visceral fibers/sympathetic chain)	Multi-level unilateral segmental somatic and visceral	Consider continuous PVB	Strongly consider unless contraindicated
Intercostal nerve block	Intercostal nerve with lateral and anterior cutaneous branches, muscle and pleural branches	Single-level unilateral lateral and anterior somatic block	Consider if unable to use TEA or PVB	Consider, possibly in combination with other chest wall blocks
Serratus anterior plane block	Lateral cutaneous branch of intercostal nerve	Multi-level anterolateral somatic block	Consider if unable to use TEA or PVB	Consider, possibly in combination with other chest wall blocks
Erector spinae plane block	Dorsal ramus, potentially ventral ramus/intercostal nerve and visceral fibers/sympathetic chain	Multi-level unilateral posterior somatic block, potential segmental somatic and visceral block	Consider if unable to use TEA or PVB	Consider, possibly in combination with other chest wall blocks

PVB, paravertebral block; TEA, thoracic epidural analgesia.