Multiple studies have confirmed that erector spinae block is effective in thoracic and breast surgeries. However, studies which investigate the efficacy of this block in cardiac surgery are scarce. This study aimed to compare continuous erector spinae block with multimodal intravenous analgesia in coronary bypass surgery. Methods: Forty patients undergoing coronary bypass surgery were divided into either group A (IV) (n = 20) who received multimodal intravenous analgesia or group B (ES) (n = 20) who had continuous erector spinae block. We compared the two groups regarding Visual Analog Scale (VAS) till 48 h after extubation, total perioperative opioid consumption, post-extubation peak inspiratory flow, duration of mechanical ventilation and ICU stay. Results: Group B showed a significantly lower VAS score than group A. intraoperative fentanyl was significantly less in group B (403.75 ± 44.63) versus (685 ± 99.47) in group A, p = 0.00. Postoperative morphine doses were 50% less in group B; (15.9 ± 2.63) versus (32.3 ± 5.04) in group A, p = 0.00. Peak inspiratory flow was significantly higher in group B after extubation. Duration of ventilation was shorter in group B (4.96 ± 0.71 h) versus (6.08 ± 0.69) in group A, p = 0.00. In addition, ICU stay was also shorter in group B (35.52 ± 3.87 h) versus (47.06 ± 5.08 h) in group A, p = 0.00. No clinically significant adverse effects were recorded. Conclusion: Ultrasound-guided bilateral continuous erector spinae block produced safe and effective analgesia for 48 h after extubation following coronary bypass surgery. It also reduced perioperative opioid consumption and allowed early tracheal extubation without major adverse effects.

Excruciating pain is a common complication following breast surgery which can be effectively treated with double path PECS I and II blocks. Sixty patients undergoing breast surgery were randomly assigned into two groups: Single-path (SP) group received a single-path pectoral nerve (PECS) I and II block, by injecting 0.25% bupivacaine 15 ml into the space between the serratus muscle and the pectoralis minor muscle, then withdrawing the needle to inject equivalent dose of bupivacaine in the plane between the pectoralis muscles. Double path group (DP) received double path block; bupivacaine 0.25% 15 ml injected into the space between pectoralis muscles through one puncture and a similar dose of bupivacaine was injected into the potential space between pectoralis minor muscle and serratus muscle through another puncture. Performance time of technique, the onset and length of the sensory block, visual analogue pain ratings (VAS), satisfaction scores, postoperative analgesic requirements and success rate were the outcomes. Single-path block had a faster performance time. Pain scores were similar at all time periods, except for 10 hours postoperatively, where double-path group had lower pain scores. In the double path block, the onset was faster and sensory block lasted longer. Double-path injection group had higher satisfaction levels. The use of double-path pectoral blocks was a beneficial approach, as it was associated with a faster onset, higher satisfaction levels, and a longer duration of analgesia.