Postoperative Outcomes of Analgesic Management with Erector Spine Plane Block at T5 Level in Pediatric Patients Undergoing Cardiac Surgery with Sternotomy: A Cohort Study

Abstract

Introduction

There is limited evidence on the impact of erector spinae plane block (ESPB) as part of multimodal analgesia in pediatric population undergoing cardiac surgery.

Methods

A retrospective cohort study was conducted in patients under 18 years of age, who underwent cardiac surgery Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) ≤3 by sternotomy. The study aims to evaluate the effect of ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery compared to conventional analgesia (CA) on relevant clinical outcomes: length of hospital stay, length of ICU stay, opioid consumption, time to extubation, mortality, and postoperative complications. The participants included were treated in a reference hospital in Colombia from July 2019 to June 2022.

Results

Eighty participants were included, 40 in the ESPB group and 40 in the CA group. There was a significant decrease (Log rank test p = 0.007) in days to length of hospital stay in ESPB group (median 6.5 days (IQR: 4–11)) compared to the CA group (median 10.5 days (IQR: 6–25)). Likewise, there was a higher probability of discharge from the ICU in the ESPB group (HR 1.71 (95% CI: 1.05–2.79)). The ESPB group had lower opioid consumption (p < 0.05). There were no differences in time to extubation, mortality, and postoperative complications.

Conclusion

ESPB as part of multimodal analgesia in pediatric patients undergoing cardiac surgery is feasible and associated with shorter hospital length of stay, faster ICU discharge and lower opioid consumption.

Keywords:

• erector spinae plane block
• cardiac surgery procedures
• pediatric age group
• anesthesia
• perioperative
• pediatric anesthesia

Abbreviations

ESPB, erector spine plane block; CA, conventional analgesia; EC, extracorporeal circulation; HR, hazard ratio; ERAS, Enhanced Recovery After Strategy; ICU, intensive care unit; LAST, Local anesthetic intoxication; VAS, visual analog scale; NRS, numerical rating scale.

Acknowledgments

We would like to thank Fundación Valle del Lili and the group of anesthesiologists of the same institution.

Disclosure

The authors report no conflicts of interest in this work.