Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.

ABSTRACT

OBJECTIVE: Regional analgesia continues to evolve with the introduction of ultrasound-guided fascial plane blocks. Erector spinae plane block (ESPB) is a novel technique gaining recent acceptability as a perioperative modality of analgesia in various thoracic and abdominal surgeries. However, literature on the use of ESPB in pediatric cardiac surgery is limited. DESIGN: A prospective, randomized, single-blind, comparative study. SETTING: Single-institution tertiary referral cardiac center. PARTICIPANTS: Eighty children with acyanotic congenital heart disease undergoing cardiac surgery through midline sternotomy. INTERVENTIONS: The subjects were allocated randomly into 2 groups ESPB (group B, n = 40) received ultrasound-guided bilateral ESPB at the level of T3 transverse process and control (group C, n = 40) receiving no block. MEASUREMENTS AND MAIN RESULTS: The postoperative pain was assessed using Modified Objective Pain Scores (MOPS) which were evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after extubation. Group B demonstrated significantly reduced MOPS as compared with group C until the 10th postoperative hour (p < 0.0001), with comparable MOPS at the 12th hour. The consumption of postoperative rescue fentanyl was also significantly less in group B in comparison to group C (p < 0.0001) with a longer duration to first rescue dose requirement in group B. In addition, the group B showed lower postoperative sedation scores and intensive care unit stay in contrast to group C. CONCLUSION: Ultrasound-guided bilateral ESPB presents a simple, innovative, reliable, and effective postoperative analgesic modality for pediatric cardiac surgeries contemplated through a midline sternotomy.