Reduced Postoperative Opioid Use Following Liposomal Bupivacaine Erector Spinae Blocks for Nuss Procedure

Regional nerve blocks may improve perioperative pain control in pediatric patients undergoing thoracic surgery, potentially minimizing opioid use and improving outcomes. We sought to understand the association between regional block and opioid use postoperatively in pediatric patients undergoing the Nuss procedure for pectus excavatum.

We performed a single-site retrospective cohort study of patients ≤18 years-old between May 2021 and July 2024. Patients with a diagnosis of pectus excavatum and meeting standard criteria for candidacy for surgical correction who underwent minimally invasive repair of pectus excavatum via Nuss procedure were included. All patients underwent cryoablation and received either erector spinae plane blocks with liposomal bupivacaine (LB) or plain bupivacaine or ropivacaine. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between perioperative regional block and opioid use as determined by morphine milligram equivalents (MME).

During the study period, 82 patients were included. The average age was 15 years (SD 1.6) and patients were majority male (83%, n = 68). A total of 39 patients (48%) underwent perioperative blocks using LB. Total MME was significantly higher in the plain bupivacaine/ropivacaine group (183 versus 78, P < 0.001). Evaluation of total MME consumption by postoperative day demonstrated significantly higher opioid and opioid-equivalent use in the plain bupivacaine/ropivacaine group for all time points (P < 0.001 postoperative day #0-2). No difference was seen in hospital length of stay between groups.

These findings suggest erector spinae plane blocks with LB may be considered an effective alternative for perioperative analgesia in pediatric thoracic surgery patients.