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J Cardiothorac Vasc Anesth. 2019 Jun;33(6):1659-1667. doi: 10.1053/j.jvca.2018.11.021. Epub 2018 Nov 19.

Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery-A Patient-Matched, Controlled Before-and-After Study.

Author information

1
Department of Anesthesiology and Critical Care Medicine, Vinmec International Hospital, Hanoi, Vietnam.
2
Department of Cardiac Surgery, Vinmec International Hospital, Ho Chi Minh City, Vietnam.
3
Department of Anesthesiology and Critical Care Medicine, Vinmec International Hospital, Ho Chi Minh City, Vietnam.
4
Department of Anesthesiology and Critical Care Medicine, Hospital Virgen de la Arrixaca, Murcia, Spain.
5
Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Cedex, France; Montpellier NeuroSciences Institute, Montpellier University, Montpellier, France. Electronic address: x-capdevila@chu-montpellier.fr.

Abstract

OBJECTIVES:

Open cardiac surgery may cause severe postoperative pain. The authors hypothesized that patients receiving a bundle of care using continuous erector spinae plane blocks (ESPB) would have decreased perioperative opioid consumption and improved early outcome parameters compared with standard perioperative management.

DESIGN:

A consecutive, patient-matched, controlled before-and-after study.

SETTING:

Two tertiary teaching hospitals.

PARTICIPANTS:

The study comprised 67 consecutive patients undergoing elective cardiac surgery with cardiopulmonary bypass.

INTERVENTIONS:

In a controlled before-and-after trial, this study compared a historical group of 20 consecutive open cardiac surgery patients matched with a prospective group of 47 consecutive patients receiving continuous bilateral ESPB (0.25 mL/kg/side of ropivacaine 0.5%) after general anesthesia induction. For postoperative analgesia, both groups received paracetamol. The control group received intravenous (IV) morphine, 0.5 mg/h, and IV nefopam, 100 mg/24 h. In the ESPB group, 8 hours after the loading dose, catheters were connected to a pump infusing intermittent automatic boluses of ropivacaine 0.2% every 6 hours. If needed, for both groups, rescue analgesia was provided with IV ketorolac, 30 mg, and IV morphine, 30 µg/kg.

MEASUREMENTS AND MAIN RESULTS:

Morphine consumption in the first 48 hours was significantly decreased in the ESPB group (40 [25-45] mg in the control group compared with 0 [0-0] mg in the ESPB group [p < 0.001]) as was intraoperative sufentanil (0.8 [0.6-0.9] µg/kg/h and 0.2 [0.16-0.3] µg/kg/h, respectively; p < 0.001). Times to chest tube removal, first mobilization, pain (Visual Analogue Scale) values 2 hours after chest tube removal, pain values at rest 1 month after surgery, and postoperative adverse events were significantly decreased in the ESPB group. There was no difference for extubation time and pain during first mobilization.

CONCLUSION:

The authors report for the first time that the use of a bundle of care including a continuous bilateral ESPB is associated with a significant decrease in intraoperative and postoperative opioid consumption, optimized rapid patient mobilization, and chest tube removal after open cardiac surgery.

KEYWORDS:

continuous erector spinae plane block; morphine consumption; open cardiac surgery; postoperative rehabilitation

PMID:
30665850
DOI:
10.1053/j.jvca.2018.11.021

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