Background & Aims
The effective analgesia following cardiac surgery with minimum opioid usage prevent post-operative pulmonary complications. The study aimed to assess the analgesic efficacy and safety of Ultrasound guided single shot bilateral Erector spinae plane (ESP) block compared to conventional intravenous patient controlled opioid analgesia in patients undergoing cardiac surgeries with midline sternotomy.
Methods
Total 102 patients belonging to ASA status II and III, aged between 18 to 70 years, scheduled for elective cardiac surgery were enrolled and randomly allocated into two groups. The patient in group 1 received ESP block with 0.3 ml/kg of 0.5% ropivacaine under ultrasound guidance before anaesthesia induction at T5 spinous level, while patients in group 2 did not receive any block. After surgical procedures, patients were sent to the intensive care unit and extubated in accordance with protocol. The primary objective was on comparing post-operative fentanyl consumption within the first 24 hours of ICU stay after extubation. Data collected were analysed using the Chi-square test or Students’ t-test with the help of SPSS 22.0.
Results
The median fentanyl (IQR)(range) consumed (in µg) in first 24 h of ICU stay was significantly lower in ESP block group [160 (71.50). (10-420)] compared to IV PCA fentanyl group [380 (132.50) (130-600)](P value <0.001).
Conclusions
Use of bilateral ESP block provides effective analgesia promoting early extubation of patients, and also reduces post-operative opioid consumption and its associated side effect with better patient’s satisfaction in relieving acute postoperative pain after cardiac surgery.
References
1. Kar P, Ramachandran G. Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks. Ann Card Anaesth. 2020;23(2):200.
2. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41(5):621–7.