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Erector spinae plane blocks for opioid-sparing multimodal pain management after pediatric cardiac surgery

Nathalie Roy¹, M Fernanda Parra¹, Morgan L Brown²

¹Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass.

The Journal of Thoracic and Cardiovascular Surgery

|March 17, 2024

Insights

Bilateral continuous erector spinae plane blocks (B-ESpB) are safe for pediatric cardiac surgery patients, reducing opioid use within 48 hours. This regional anesthesia technique supports enhanced recovery protocols in children.

Area of Science:

Anesthesiology
Pediatric Surgery
Regional Anesthesia

Background:

Peripheral regional anesthesia is explored for improving patient recovery.
Enhanced recovery after cardiac surgery (ERACS) programs aim to optimize surgical outcomes.
The efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) in pediatric cardiac surgery remains under investigation.

Purpose of the Study:

To evaluate the effectiveness of B-ESpB for postoperative pain management in children undergoing cardiac surgery.
To assess the impact of B-ESpB on the recovery process within an ERACS program.
To determine the safety profile of B-ESpB in this pediatric population.

Main Methods:

Prospective enrollment of pediatric patients (2-17 years) in an ERACS program receiving B-ESpB post-cardiac surgery.
Continuous postoperative infusions via catheters were administered.
Retrospective matching of B-ESpB patients with control patients within the ERACS program for outcome comparison.

Main Results:

Forty B-ESpB patients were matched with 78 controls; no major complications from B-ESpB were observed.
B-ESpB patients received significantly fewer opioids at 24 and 48 hours postoperatively (p < 0.05).
No significant differences were found in early mobilization, length of stay, or overall complications between groups.

Conclusions:

Bilateral continuous erector spinae plane blocks are a safe analgesic technique for pediatric cardiac surgery.
B-ESpB, as part of a multimodal pain strategy in ERACS, provides effective pain control and reduces opioid requirements in the initial 48 hours.
This regional anesthesia approach contributes to successful enhanced recovery in pediatric cardiac surgical patients.

Read full analysis

Abstract

Objective:

Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery.

Methods:

Patients aged 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the enhanced recovery after cardiac surgery program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling.

Results:

Forty patients receiving B-ESpB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31 minutes. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalents than controls at 24 hours (0.60 ± 0.06 vs 0.78 ± 0.04 mg/kg; P = .02) and 48 hours (1.13 ± 0.08 vs 1.35 ± 0.06 mg/kg; P = .04), respectively. Both groups had low median pain scores per 12-hour period. There was no difference in early mobilization, length of stay, or complications.

Conclusions:

B-ESpBs are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an enhanced recovery after cardiac surgery program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.

Keywords:

ERAS cardiac surgery opioids pediatric regional anesthesia

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