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

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pain Management

Background:

• Ineffective postoperative pain management after pediatric cardiac surgery can negatively impact patient recovery.
• The erector spinae plane (ESP) block is a recognized method for perioperative pain control.
• This study investigated the efficacy of bilateral ESP blocks in pediatric cardiac surgical patients.

Purpose of the Study:

• To evaluate the effectiveness and safety of bilateral ESP blocks in pediatric patients undergoing cardiac surgery via median sternotomy.
• To determine if bilateral ESP blocks reduce intraoperative opioid consumption and postoperative pain.

Main Methods:

• A double-blinded randomized controlled trial was conducted with 98 pediatric patients (6 months to 7 years) undergoing cardiac surgery.
• Patients were randomized into two groups: one receiving bilateral ultrasound-guided ESP blocks (ES group) and a control group (N group).
• Primary outcome was intraoperative fentanyl consumption; secondary outcomes included postoperative morphine use, time to first analgesia, and FLACC pain scores.

Main Results:

• The ES group showed significantly lower intraoperative fentanyl consumption (4.3 ± 1.9 µg.kg⁻¹) compared to the N group (6.7 ± 3 µg.kg⁻¹).
• Postoperative morphine consumption was also significantly lower in the ES group (0.4 ± 0.2 mg.kg⁻¹) versus the N group (0.5 ± 0.2 mg.kg⁻¹).
• The time to the first need for postoperative analgesia was significantly longer in the ES group (231.6 ± 104.5 min) than in the N group (108.8 ± 47.8 min).

Conclusions:

• Bilateral ultrasound-guided ESP blocks are effective in reducing perioperative opioid consumption in pediatric patients undergoing sternotomy for cardiac surgery.
• This technique also significantly decreases postoperative pain scores, contributing to better pain management.
• ESP blocks offer a safe and effective strategy for managing pain in this vulnerable patient population.