Continuous Erector Spinae Plane (ESP) Block for Postoperative Analgesia after Minimally Invasive Mitral Valve Surgery

Erector Spinae Block. A Narrative Review

“…The ESP block targets the erector spinae plane, which lies in the chest wall between the anterior surface of the cephalo caudal oriented erector spinae muscles and the posterior surface of the spinal transverse processes. LA is deposited in the fascial plane deep to the erector spinae muscle and superficial to the tips of the transverse processes, from where it diffuses to the dorsal and ventral rami of spinal nerves, achieving an extensive multi-dermatomal sensory block of the posterior, lateral, and anterior thoracic wall [1][2][3][4][5][6][7][8].…”

“…Studies have shown that the spread of LA in the paravertebral space in the cephalic and caudal direction can lead to analgesia from C7-T2 to L2-3 [4]. For that reason the block was successfully used in acute pain management in pneumothorax surgery (ESP block at T6 level) [26], applied in video-assisted thoracoscopic surgery (VATS) [27], minimally invasive mitral valve surgery via thoracotomy incisions (ESP block at the level of the T7 transverse process) [8], postoperative analgesia after caesarean section (at T9 level) [28], postoperative analgesia in retropubic radical prostatectomy (over the 12th thoracic vertebrae) [29], different laparoscopics abdominal surgeries [19], laparoscopic cholecystectomy in the ambulatory setting [30] and bariatric surgery [17], as examples.…”

“…On the other hand, due to the lack of evidence in quantity of LA necessary to cover one dermatome after a bolus injection, De Cassai et al [49] performed a review of the medical literature. Indeed, after an injection of LA, the volume needed to cover one dermatome widely varies from 2.5 mL [1,26,8,2] to 6.6 mL [50,7], with a median value of 3.4 mL. Furthermore, the maximum number of dermatomes reached by a single bolus in ESP was of 9 dermatomes after a 30 mL bolus [33].…”

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

“…Yalamuri et al demonstrated significantly improved pain control after performing Pectoral Fascial (PECS) I and II nerve blocks using liposomal bupivacaine following a minimally invasive mitral valve repair. Similarly, Leyva et al showed that using a continuous erecter spinae plane (ESP) catheter as part of a multimodal pain management treatment plan provided effective analgesia and avoided the use of IV narcotics following minimally invasive cardiac surgery . Likewise, Adhikary et al reported a case series of five patients who received continuous ESP blocks for postoperative pain control following minimally invasive LVAD procedures.…”

Mitral Valve Replacement in a Patient With Systemic Mastocytosis

“…The ESP block recently has been used successfully in the form of a single injection as well as in continuous infusion in the management of postoperative pain after thoracic and cardiac surgery. 13 In summary, to avoid triggers for MC release in the perioperative period, a careful planning of preoperative, intraoperative, and postoperative care should be made by the hematologist, anesthesiologist, and cardiac care physicians involved in their management.…”