Bilateral Erector Spinae Blocks Decrease Perioperative Opioid Use After Pediatric Cardiac Surgery.
OBJECTIVE
The present study examined the feasibility and efficacy of continuous bilateral erector spinae blocks for post-sternotomy pain in pediatric cardiac surgery.


DESIGN
Prospective cohort study; patients were retrospectively matched 1:2 to control patients. Conditional logistic regression was used to compare dichotomous outcomes, and generalized linear models were used for continuous measures, both accounting for clusters.


SETTING
Quaternary children's hospital, university setting.


PARTICIPANTS
The study comprised 10 children ages five-to-17 years undergoing elective cardiac surgery requiring cardiopulmonary bypass.


INTERVENTIONS
Ultrasound-guided bilateral erector spinae blocks at the conclusion of the cardiac surgical procedure, with postoperative infusion of ropivacaine until chest tube removal. Postoperative management otherwise followed standardized guidelines.


MEASUREMENTS AND MAIN RESULTS
Patient characteristics were similar in the two groups. The median time to completion of the bilateral blocks was 16.0 minutes (interquartile range [IQR] 14.8-19.3), and no major adverse events were identified. Pain scores were low in both groups. Postoperative opioid use at 48 hours, rendered as oral morphine equivalents, was significantly reduced in the patients receiving the blocks. Cluster-adjusted squared-root-transformed means ± standard error were 0.89 ± 0.06 mg/kg for patients receiving the blocks versus 1.05 ± 0.06 mg/kg for control patients (p = 0.04; raw medians 0.81 [IQR 0.41-1.04] v 1.10 [IQR 0.78-1.35] mg/kg, respectively). There were no differences in recovery metrics, length of stay, or complications.


CONCLUSIONS
Bilateral erector spinae blocks were associated with a reduction in opioid use in the first 48 hours after pediatric cardiac surgery compared with a matched cohort from the enhanced recovery program. Larger studies are needed to determine whether this can result in an improvement in recovery and patient satisfaction.
['Roy|Nathalie|N|', 'Brown|Morgan L|ML|', 'Parra|M Fernanda|MF|', 'Sleeper|Lynn A|LA|', 'Alrayashi|Walid|W|', 'Nasr|Viviane G|VG|', 'Eklund|Susan E|SE|', 'Cravero|Joseph P|JP|', 'Del Nido|Pedro J|PJ|', 'Brusseau|Roland|R|']
D000293:Adolescent D000701:Analgesics, Opioid D006348:Cardiac Surgical Procedures D002648:Child D002675:Child, Preschool D006801:Humans D009407:Nerve Block D010149:Pain, Postoperative D011446:Prospective Studies D012189:Retrospective Studies
opioid pediatric cardiac surgery ERAS Enhanced Recovery After Surgery postoperative pain regional anesthesia