Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via Sternotomy: A Randomized Controlled Trial

Abstract

Background: Ineffective management of postoperative pain following pediatric cardiac surgeries adversely affects a patient’s postoperative course. The erector spinae plane (ESP) block has been described in the literature regarding perioperative pain management. We hypothesized that bilateral ESP blocks in pediatric patients would decrease intraoperative fentanyl consumption, reduce the need for postoperative morphine consumption, and improve pain scores. Objectives: The aim of this double-blinded randomized controlled trial was to assess the efficacy and safety of bilateral ESP blocks in pediatric patients undergoing cardiac surgeries through a median sternotomy. Methods: The study involved 98 children aged 6 months to 7 years who were American Society of Anesthesiologists (ASA) II and III and scheduled for cardiac surgery through a median sternotomy. Patients were divided randomly into 2 groups: the ES group (n = 50) who received bilateral ultrasound-guided ESP blocks, and the N group (n = 48) who received no block. The primary outcome was the total dose of administered fentanyl intraoperatively. Secondary outcomes included morphine consumption in the first 24 hours postoperatively; the length of time before the first need for postoperative analgesia; and FLACC (face, legs, activity, consolability, and cry) scores at the first and second hours postoperatively and every 4 hours, with readings taken for a period of 24 hours. Results: There were statistically significantly higher levels of administered fentanyl intraoperatively (6.7 ± 3 vs 4.3 ± 1.9 µg.kg-1) and postoperative morphine consumption (0.5 ± 0.2 vs 0.4 ± 0.2 mg.kg-1) in the N group compared with the ES group (P ˂ 0.001). Moreover, the timing of the first rescue analgesia was significantly delayed in the ES group compared with the N group (231.6 ± 104.5 vs 108.8 ± 47.8 minutes). Conclusions: Bilateral ultrasound-guided ESP blocks can be used to reduce perioperative opioid consumption in pediatric patients undergoing cardiac surgery through a sternotomy. It also can be used to decrease postoperative pain scores.

Erector Spinae Plane Block for Postoperative Analgesia in Cardiac Surgeries- A Systematic Review and Meta-Analysis

“…Finally, we included 16 studies which included 1110 patients for analysis (489 in ESPB and 621 in control), [ Figure 1 ]. [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ] Table 1 summarizes the details of all the studies included in the analysis.…”

“…Eight studies reported 24-hr morphine consumption[ 14 15 16 17 18 19 20 21 ] and 5 studies[ 22 23 24 25 26 ] reported 48-hr opioid consumption. For 24-hr morphine consumption, there were 232 patients in ESPB group and 240 patients in the control group.…”

The Year in Review: Anesthesia for Congenital Heart Disease 2022

“…Two different randomized controlled trials investigated the impact of erector spinae plane (ESP) blocks in patients undergoing sternotomy. In the first, Gado et al 12 randomized 98 children aged 6 months to 7 years to pre-incision, bilateral, single-shot ESP blocks vs no block. 12 Intraoperative fentanyl and postoperative morphine consumption were significantly reduced in the block group.…”

“…In the first, Gado et al 12 randomized 98 children aged 6 months to 7 years to pre-incision, bilateral, single-shot ESP blocks vs no block. 12 Intraoperative fentanyl and postoperative morphine consumption were significantly reduced in the block group. The time to first postoperative opioid rescue medication was significantly delayed in the block group.…”

Current evidence of ultrasound guided fascial plane blocks for cardiac surgery: a narrative literature review

“…Conversely, Karacaer et al [ 49 ] noted no significant differences between the ESP block and control groups in terms of the pain score, sedation score, extubation time, and length of ICU stay. Gado [ 50 ] assessed the efficacy and safety of bilateral ESP blocks in pediatric patients undergoing cardiac surgeries through a median sternotomy. Perioperative opioid consumption was reduced in the ESP block group compared with the control group with comparable postoperative complications such as vomiting, itching, and respiratory depression.…”