Erector Spinae Plane Block Decreases Chronic Postoperative Pain Severity in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients’ moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients’ satisfaction and reduce perioperative complications.

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

“…186 Preventative perioperative use of ESPB was found to reduce the incidence and severity of persistent postoperative pain after off-pump CABG surgery (category B1-B evidence). 187 Continuous ESPB-related analgesia with LA alone 188 or when combined with dexamethasone 189 or dexmedetomidine 190 was found to be comparable to epidural 188 (for the first 12 hours) as well as superior to patient-controlled analgesia 189 and intravenous dexmedetomidine 190 with regard to pain scores 188,190 and opioid consumption 189 after cardiac surgery (category A2-B evidence 189,190 /category A3-E evidence 188 ).…”

“…186 Preventative perioperative use of ESPB was found to reduce the incidence and severity of persistent postoperative pain after off-pump CABG surgery (category B1-B evidence). 187…”

Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial

“…Both studies showed that ESPB was effective. However, one study was retrospective [24], and the other was an observational study [25]. The current trial is a high-quality RCT; therefore, it provides primary evidence that performing ESPB in OPCAB patients may be a safe analgesic option for the primary care physician.…”

“…However, there are only a limited number of RCTs [23]. To the best of the authors' knowledge, there are two studies evaluating the effectiveness of ESPB in patients undergoing OPCAB [24,25]. Both studies showed that ESPB was effective.…”

Practical strategies for the prevention and management of chronic postsurgical pain

“…In a clinical study of extremity amputation, the prolonged use of peripheral nerve block catheters considerably reduced the incidence and severity of phantom limb pain [73]. Recently, several ultrasound-guided interfascial plane blocks have shown promising results in preventing CPSP [74][75][76]. However, the precise effects of these blocks on CPSP remain difficult to determine.…”