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

Figures & data

Table 1 Demographic, Clinical and Intraoperative Characteristics of the Study Population

	Overall, n = 80	CA Group, n = 40	ESPB Group, n = 40	p value
Demographic characteristics
Age (months) mean (SD)	44.49 (62.09)	45.59 (67.03)	43.4 (57.56)	0.17
Age (months)^†*	9.5 (4–54)	7.5 (2–72)	15.5 (6–54)
Gender, n (%)
Female	45 (56.25)	23 (57.5)	22 (55)	0.5
Male	35 (43.75)	17 (42.50)	18 (45)
Clinical characteristics
Weight (kg)^†*	7.5 (4.8–17)	6 (3.65–21.55)	9.5 (6.1–15.5)	0.08
Body surface^†	0.39 (0.282–0.77)	0.33 (0.236–0.95)	0.47 (0.334–0.71)	0.08
Comorbidities, n (%)	50 (62.5)	26 (65)	24 (60)	0.92
Pulmonary	18 (22.5)	9 (22.5)	9 (22.5)
Renal	4 (5)	0 (0)	4 (5)
Endocrine	8 (10)	3 (7.5)	5 (12.5)
Gastrointestinal	15 (18.75)	5 (12.5)	10 (25)
Neurologic	17 (21.25)	7 (17.50)	10 (25)
Prematurity	15 (18.75)	7 (17.50)	8 (20)
Others	31 (38.75)	18 (45)	13 (32.5)
Surgical procedure, n (%)
RACHS-1 Risk 1	13 (16.25)	5 (12.5)	8 (20)	0.6
RACHS-1 Risk 2	40 (50)	20 (50)	20 (50)
RACHS-1 Risk 3	27 (33.75)	15 (37.50)	12 (30)
Intraoperative variables^†*
Time of cardiopulmonary bypass (minutes)^†	57 (32–78)	66 (49–85)	52 (29–72)	0.05
Time of aortic arch clamp (minutes)^†	34 (18–52)	37 (23–56)	32 (15–42)	0.12

Notes: ^†Median (IQR). *p value obtained by the Mann–Whitney U-test.

Table 2 Comparison of Postoperative Clinical Outcomes Between Therapeutic Groups

Variable	Overall, n = 80, Median (IQR)	CA Group, n = 40, Median (IQR)	ESPB Group, n = 40, Median (IQR)	p value
Global in-hospital stay (days)****	8 (5–17)	10.5 (6–25)	6.5 (4–11)	0.007
ICU stay (days)***	5 (3–10.5)	6 (3–14.5)	4 (2–7)	0.01
Time to extubation (hours)**	17 (5–120)	21 (6–140)	6.5 (3–72)	0.12
Time to first analgesia (hours)** n=26	3 (2–7)	6 (4–18)	3 (2–7)	0.30
Opioid consumption at 48 POP hours (micrograms/kg)** n=57	456.45 (267.94–2706.63)	1041.66 (294.88–8333.33)	378.40 (250.2–534.1)	0.0011

Notes: **p value obtained by Mann–Whitney U-test. ***p value obtained by Wilcoxon (Breslow) test. ****Value obtained by the Log rank test.

Table 3 Comparison of Postoperative Adverse Events Between Therapeutic Groups

Variable	Overall, n = 80	CA Group, n = 40	ESP Group, n = 40	P value
None	47 (58.75)	22 (55)	25 (62.5)	0.5
Cardiovascular	3 (3.75)	1 (2.5)	2 (5)
Pulmonary and Pneumonia	8 (10)	4 (10)	4 (10)
Fever	4 (5)	3 (7.5)	1 (2.5)
Gastrointestinal	4 (2.5)	1 (2.5)	3 (7.5)
Bleeding and reintervention	2 (2.5)	1 (2.5)	1 (2.5)
Electrolytic disturbances	1(1.25)	1 (2.5)	0
Tracheostomy and pulmonary	1 (1.25)	1 (2.5)	0
Cardiovascular and pulmonary	1 (1.25)	0	1 (2.5)
Cardiovascular and gastrointestinal (NV)	1 (1.25)	0	1 (2.5)
Cardiovascular and neurologic (convulsions)	1 (1.25)	0	1 (2.5)
Cardiovascular and urinary	1 (1.25)	1 (2.5)	0
Cardiovascular, pulmonary and infectious	1 (1.25)	0	1 (2.5)
Pulmonary and renal or pulmonary with tracheostomy	2 (2.5)	2 (5.0)	0
Gastrointestinal and pulmonary	1 (1.25)	1 (2.5)	0
Gastrointestinal and bleeding with blood transfusion	1 (1.25)	1 (2.5)	0
Reoperation for bleeding control	1 (1.25)	1 (2.5)	0

Figure 1 Kaplan–Meier analysis of time to hospital discharge according to the type of analgesic intervention.

Table 4 Comparison of Unadjusted and Adjusted Hazard Ratios in Multivariate Cox Regression Models

Variable /Outcome	Hospital Discharge
	Unadjusted HR	HR*
ESPB group	1.73 (95% CI: 1.10–2.72)	1.79 (95% CI: 1.11–2.87)
Age (months)	1.00 (95% CI: 1.0–1.0)	–
Gender (male)	1.20 (95% CI: 0.75–1.93)	–
Comorbidities	0.50 (95% CI: 0.31–0.82)	0.49 (95% CI: 0.29–0.82)
RACHS-1 Classification – Risk 2	0.18 (95% CI: 0.09–0.39)	0.27 (95% CI: 0.12–0.58)
RACHS-1 Classification – Risk 3	0.09 (95% CI: 0.04–0.22)	0.17 (95% CI: 0.07–0.39)
Cardiopulmonary bypass (min)	0.99 (95% CI: 0.98–1.00)	–
Opioid consumption (µg/kg)	0.99 (95% CI: 0.99–1.01)	–
Adverse events	0.46 (95% CI: 0.29–0.751)	0.51 (95% CI: 0.30–0.85)
	ICU Discharge
	Unadjusted HR	HR*
ESPB group	1.75 (95% CI: 1.09–2.80)	1.71 (95% CI: 1.05–2.79)
Age (months)	1.00 (95% CI: 1.00–1.00)	–
Gender (male)	1.27 (95% CI: 0.80–2.01)	–
Comorbidities	0.42 (95% CI: 0.26–0.69)	0.42 (95% CI: 0.25–0.72)
RACHS-1 Classification - Risk 2	0.22 (95% CI: 0.11–0.45)	0.31 (95% CI: 0.50–0.65)
RACHS-1 Classification - Risk 3	0.13 (95% CI: 0.05–0.28)	0.20 (95% CI: 0.08–0.47)
Cardiopulmonary bypass (min)	0.99 (CI:95%: 0.98–0.99)	–
Opioid consumption (µg/kg)	0.99 (95% CI: 0.99–0.99)	–
Adverse events	0.54 (95% CI: 0.34–0.87)	0.67 (95% CI: 0.40–1.11)

Notes: *Cox regression model using type of treatment, comorbidities, complications, and RACHS-1 classification.

Figure 2 Kaplan–Meier analysis of time to ICU discharge according to the type of analgesic intervention.