Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial

Year 2022, Volume: 5 Issue: 1, 150 - 155, 17.01.2022

Bülent Barış Güven , Tuna Ertürk , Aysin Ersoy

https://doi.org/10.32322/jhsm.1013908

Cited By: 6

Abstract

Introduction: There are few randomized controlled trials examining the effectiveness of bilateral Erector Spinae Plane Block (ESP) with patients undergoing cardiac surgery. The effect of bilateral ESP block on postoperative pain levels and analgesic consumption for patients undergoing open-heart surgery was examined in this single-blind, randomized, controlled trial.
Material and Method: 54 patients who underwent cardiac surgery with open median sternotomy under general anesthesia between May 2020 and June 2021 were included in the study. Patients were randomized into two groups, each consisting of 27 patients, one with 40 ml of 0.25% bupivacaine and bilateral ESP block, the other with no block implementation (control group). Demographic data, operation type, length of stay in the Intensive Care Unit (ICU), numerical rating scale (NRS) values in the first 24 hours after extubation, and morphine consumption values of the patients were recorded for the study.
Results: In the study, 4 patients were excluded from follow-up due to prolonged intubation in the postoperative period. The data of a total of 50 patients (ESP group n=25; Control group n=25) were analyzed. The duration before first analgesic (mean±SD: 459.2±92.8 min.) of the ESP group was statistically longer than those in the control group (mean±SD: 142.0±56.6 min.) (p<0.001). The total length of stay in the ICU and rate of nausea-vomiting were lower for the ESP group than for the control group (p<0.05). Total morphine consumption (mean±SD: 5.1±3.1 mg) of the ESP group in the first 24 hours was statistically lower (p<0.001) compared to the consumption of the control group (mean±SD: 14.8±4.2 mg). NRS scores were significantly lower for the ESP group at postoperative 1st, 2nd, 4th, 6th, and 8th hours compared to the control group (p<0.05).
Conclusion: ESP block applied bilaterally in adult cardiac surgeries decreased postoperative pain scores and morphine consumption. At the same time, it was observed that the length of stay of the patients in the ICU was reduced and there were no complications.

Keywords

Erector spinae plane block, Cardiac surgery, Postoperative pain, Ultrasound guidance, Fascial plane block

Supporting Institution

yok

Project Number

-

Thanks

We would like to thank the cardiovascular surgery doctors and nurses for their support and patience during the study.

References

• Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017; 152: 292-8.
• Markham T, Wegner R, Hernandez N, et al. Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: retrospective analysis of patient outcomes. J Clin Anesth 2019; 54: 76-80.
• Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database Syst Rev 2019; 3: CD006715. 
• Sun L, Li Q, Wang Q, Ma F, Han W, Wang M. Bilateral thoracic paravertebral block combined with general anesthesia vs. general anesthesia for patients undergoing off-pump coronary artery bypass grafting: a feasibility study. BMC Anesthesiol 2019; 19: 101.
• Mehta Y, Arora D, Sharma KK, Mishra Y, Wasir H, Trehan N. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery. Ann Card Anaesth 2008; 11: 91-6. 
• Kot P, Rodriguez P, Granell M, et al. The erector spinae plane block: a narrative review. Korean J Anesthesiol 2019; 72: 209-20.
• Nagaraja PS, Ragavendran S, Singh NG, et al. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth 2018; 21: 323-7.
• Bigeleisen PE, Goehner N. Novel approaches in pain management in cardiac surgery. Curr Opin Anaesthesiol 2015; 28: 89-94.
• Naveed A, Azam H, Murtaza HG, et al. Incidence and risk factors of pulmonary complications after cardiopulmonary bypass. Pakistan J Med Sci 2017; 33: 993–6.
• Khera T, Murugappan KR, Leibowitz A, et al. Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial. J Cardiothorac Vasc Anesth 2021; 35: 896-903.
• Doğan Bakı E, Kavrut Ozturk N, Ayoğlu RU, Emmiler M, Karslı B, Uzel H. Effects of parasternal block on acute and chronic pain in patients undergoing coronary artery surgery. Seminars in Cardiothoracic and Vascular Anesthesia 2016; 20: 205-12.
• Macaire P, Ho N, Nguyen T, et al. Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery-a patient-matched, controlled before-and-after study. J Cardiothorac Vasc Anesth 2019; 33: 1659-67.
• Krishna SN, Chauhan S, Bhoi D, et al. Bilateral erector spinae plane block for acute post-surgical pain in adult cardiac surgical patients: a randomized controlled trial. J Cardiothorac Vasc Anesth 2019; 33: 368-75.
• Athar M, Parveen S, Yadav M, et al. A randomized double-blind controlled trial to assess the efficacy of ultrasound-guided erector spinae plane block in cardiac surgery. J Cardiothorac Vasc Anesth 2021; S1053-0770(21)00211-1.
• Svircevic V, van Dijk D, Nierich AP, et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology 2011; 114: 271-82.
• Wilson JM, Lohser J, Klaibert B. Erector spinae plane block for postoperative rescue analgesia in thoracoscopic surgery. J Cardiothorac Vasc Anesth 2018; 32: e5-7.
• Luis-Navarro JC, Seda-Guzmán M, Luis-Moreno C, López-Romero JL. The erector spinae plane block in 4 cases of video-assisted thoracic surgery. Rev Esp Anestesiol Reanim 2018; 65: 204-8.
• Adhikary SD, Prasad A, Soleimani B, Chin KJ. Continuous erector spinae plane block as an effective analgesic option in anticoagulated patients after left ventricular assist device implantation: a case series. J Cardiothorac Vasc Anesth 2019; 33: 1063-7.
• Wyatt K, Elattary T. The erector spinae plane block in a high-risk Ehlers-Danlos syndrome pediatric patient for vascular ring repair. J Clin Anesth 2019; 54: 39-40.
• Ueshima H. Pneumothorax after the erector spinae plane block. J Clin Anesth 2018; 48: 12.
• Hamilton DL. Pneumothorax following erector spinae plane block. J Clin Anesth 2019; 52: 17.
• Huang J, Liu JC. Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2020; 20: 83.
• Taketa Y, Irisawa Y, Fujitani T. Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax. J Clin Anesth 2018; 47: 84-5.
• Ueshima H, Hiroshi O. Spread of local anesthetic solution in the erector spinae plane block. J Clin Anesth 2017; 45: 23