Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

Abstract

Introduction: One of the main challenges in cardiac surgery is effective postoperative analgesia. Erector spinae-plane block (ESP block) is a novel regional technique, introduced by Forero in 2016 for neuropathic chest pain, then used successfully for mastectomy. Aim: To establish the efficacy of the ESP block in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy. Material and methods: It is a prospective observational cohort study performed in a tertiary health center. In the treatment group, a single-shot ESP block was performed before anesthetic induction. General anesthesia was induced with etomidate, remifentanil, and rocuronium, and continued with sevoflurane and remifentanil. Remifentanil infusion was continued for 2 h post-operatively, then stopped, and the patient's trachea was extubated. Patient-controlled analgesia was started with oxycodone immediately. Total oxycodone consumption and pain severity on the visual analog scale during the first 24 h were analyzed. In the control group, no regional block was performed. Instead of remifentanil, fentanyl was used. Patients were extubated on the second day. Pain was treated with morphine, administered according to nurses' discretion. Pain intensity was evaluated on the numerical rating scale. Results: Nineteen patients were evaluated in the ESP and 25 in the control group. Mechanical ventilation time was shorter in the ESP group (0.6 (0.4-1.1) h) than in the control one (10 (8-17) h, p = 0.00001). Moreover, patients in the ESP group spent fewer days in the intensive care unit (1 (1-1) vs. (2 (2-2), p = 0.0001). Conclusions: The ESP block seems to be safe and efficient for pain control in patients undergoing right mini-thoracotomy for mitral and/or tricuspid valve repair.

Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair — a randomized controlled trial

“…In the ESP group, ultrasound-guided ESP block at the fourth thoracic level was performed before the surgery and induction of general anesthesia with Ropivacaine (0.375%; Ropimol, Molteni, Italy, 0.2 mL/kg) as described in our previous study ( Fig. 1) [13]. The maximum dosage of ropivacaine could not exceed 20 mL in this group.…”

“…The primary outcome of our study was the oxycodone consumption via PCA during the first 24 postoperative hours. Patients in the PECS + ESP group used significantly less oxycodone than individuals in the ESP group: 12 [IQR: 6-16] mg vs. 20 [IQR: 18-29] mg or 18 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 30 [27-43.5] ME (p = 0.0004) ( Fig. 6).…”

“…Our previous, prospective, cohort study demonstrated that the ESP block combined with low-dose intravenous oxycodone was an effective analgesic technique for patients who had undergone mitral or/and tricuspid valve repair via right mini-thoracotomy [13]. In that study, all patients could be weaned from mechanical ventilation within 2 h postoperatively and were transferred to the general ward on the second postoperative day.…”

Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery.

“…We have recently introduced an institutional Enhanced Recovery After Cardiac Surgery (ERAS Cardio) protocol, which includes bilateral erector spinae-plane (ESP) block as part of multimodal analgesia [2,3], as well as the use of an extremely short acting opioid (remifentanil) instead of fentanyl during the surgery and in the early postoperative period. Some researchers claim that remifentanil might not be appropriate in the population of hemodynamically compromised patients [4].…”

Erector spinae plane block for minimally invasive mitral valve surgery: a double-blind, prospective, randomised placebo-controlled trial—a study protocol

“…6 In cardiac surgery, the ESP block has been described to adequately provide perioperative analgesia in only two randomised controlled trials and several case reports and case series. [6][7][8][9][10][11] Based on these clinical reports, analgesia is believed to be achieved by paravertebral and craniocaudal spread of local anaesthetics with only a single injection. 5 This presumed paravertebral spread can anaesthetise not only the ventral and dorsal rami of the spinal nerve roots but also the autonomical fibres of the sympathetic ganglia.…”