Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery

Abstract

Objective:Continuous thoracic epidural analgesia (TEA) is compared with erector spinae plane (ESP) block for the perioperative pain management in patients undergoing cardiac surgery for the quality of analgesia, incentive spirometry, ventilator duration, and intensive care unit (ICU) duration.Methodology:A prospective, randomized comparative clinical study was conducted. A total of 50 patients were enrolled, who were randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25). Visual analog scale (VAS) was recorded in both the groups during rest and cough at the various time intervals postextubation. Both the groups were also compared for incentive spirometry, ventilator, and ICU duration. Statistical analysis was performed using the independent Student's t-test. A value of P < 0.05 was considered statistically significant.Results:Comparable VAS scores were revealed at 0 h, 3 h, 6 h, and 12 h (P > 0.05) at rest and during cough in both the groups. Group A had a statistically significant VAS score than Group B (P ≤ 0.05) at 24 h, 36 h, and 48 h but mean VAS in either of the Group was ≤4 both at rest and during cough. Incentive spirometry, ventilator, and ICU duration were comparable between the groups.Conclusion:ESP block is easy to perform and can serve as a promising alternative to TEA in optimal perioperative pain management in cardiac surgery.

Erector spinae plane block and altered hemostasis: is it a safe option? -a case series-

“…The ESP block is a fascial plane block, which is performed between the transverse processes and erector spinae muscles, with a moderate level of difficulty, and can provide adequate analgesia through multiple dermatomes by cephalocaudal spread, as reported by Ivanusic et al [ 8 ]. Although this study reported no spread of dye to the ventral rami, several (published) studies have provided evidence, supporting the idea that anterior spread of local anesthetic provides visceral fiber blockade, explaining its use in thoracic, cardiac and abdominal surgery [ 9 – 13 ]. A recent case report described Harlequin syndrome after the ESP block, which is clearly consistent with the anterior spread of local anesthetic solution responsible for sympathetic fiber chain blockade [ 14 ].…”

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

“…compared ESP block with continuous catheter infusion and TEA. [ 30 ] This study found both blocks to be equally efficacious in the initial 12 h after extubation. However, VAS scores in TEA group were found significantly higher at 24, 36, and 48 h, but the mean values in both groups nevertheless remained in the mild pain range (VAS <4).…”

<p>Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse</p>

“…Studies are ongoing to show their non-inferiority to neuraxial anesthesia. 17,18 As our case illustrates, successful neuraxial anesthesia may provide effective analgesia without the need for systemic opioids so that maintenance therapy can be sustained. Even with an effective epidural placement, patients may require an increase in concentration of local anesthesia for excellent pain control due to resistance to local anesthetic agents in opioid tolerant patients.…”