Ultrasound-Guided Continuous Bilateral Erector Spinae Plane Blocks Are Associated with Reduced Opioid Consumption and Length of Stay for Open Cardiac Surgery: A Retrospective Cohort Study

Abstract

This study tested the hypothesis that continuous bilateral erector spinae plane blocks placed preoperatively would reduce opioid consumption and improve outcomes compared with standard practice in open cardiac surgery patients. Patients who received bilateral continuous erector spinae plane blocks for primary open coronary bypass, aortic valve, or ascending aortic surgery were compared to a historical control group. Patients in the block group received a 0.5% ropivacaine bolus preoperatively followed by a 0.2% ropivacaine infusion begun postoperatively. No other changes were made to the perioperative care protocol. The primary outcome was opioid consumption. Secondary outcomes were time to extubation and length of stay. Twenty-eight patients received continuous erector spinae plane blocks and fifty patients served as historic controls. Patients who received blocks consumed less opioids, expressed as oral morphine equivalents, both intraoperatively (34 ± 17 vs. 224 ± 125 mg) and during their hospitalization (224 ± 108 vs. 461 ± 185 mg). Patients who received blocks had shorter times to extubation (126 ± 87 vs. 257 ± 188 min) and lengths of stay in the intensive care unit (35 ± 17 vs. 58 ± 42 h) and hospital (5.6 ± 1.6 vs. 7.7 ± 4.6 days). Continuous erector spinae plane blocks placed prior to open cardiac surgical procedures reduced opioid consumption, time to extubation, and length of stay compared to a standard perioperative pathway.

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.…”

“…This was described in 8 studies (ESPB-181, control-193). [ 15 17 19 24 25 26 27 29 ] The intraoperative opioid consumption (converted to IV morphine) was significantly less in the ESPB group when compared to the control (MD, −2.77; 95% CI, −4.38 to − 1.16, P = 0.00007). A random effect model was applied [ P < 0.00001); I 2 = 96%] [ Figure 4c ].…”

Regional anesthesia in cardiac surgery and electrophysiology procedures

“…Similarly in a randomized controlled, double-blind study of bilateral ESP catheters compared with sham catheters, opioid consumption was decreased by almost 65%, time-to-first rescue analgesia increased (357 vs. 124 min, respectively), duration of mechanical ventilation was decreased (88 vs. 103 min), and decreased sedation 29 . Vaughan et al 30 also showed decreased intraoperative and postoperative opioid consumption, earlier extubation, and decreased ICU and hospital LOS with bilateral ESP catheters compared with systemic analgesia.…”

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

“…Continuous bilateral erector spine plane block or infusion of local anesthetics at the median sternotomy site have been identi ed to reduce opioid consumption and LOS in hospital after cardiac surgery. [21,22] Continuous PIFB combined with RSB, covering from T 1 -T 10 , has been attempted with well analgesia in cardiac surgery. [23] More researches are needed to nd the association between postoperative analgesia and early recovery in cardiac surgery in the future.…”