Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery

Arkadiusz Kurowicki; Michal Borys; Slawomir Zurek; Beata Horeczy; Boguslaw Gaweda; Bartlomiej Belina; Bozena Trojnar; Bogumila Woloszczuk-Gebicka; Justyna Sejboth; Miroslaw Czuczwar; Kazimierz Widenka

doi:10.5114/wiitm.2019.88748

Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery

Wideochir Inne Tech Maloinwazyjne. 2020 Jun;15(2):346-350. doi: 10.5114/wiitm.2019.88748. Epub 2019 Oct 15.

Affiliations

¹ Clinical Department of Cardiac Surgery, St. Jadwiga Provincial Clinical Hospital, Rzeszow, Poland.
² 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland.
³ Anesthesiology and Intensive Care Department with the Center for Acute Poisoning, St. Jadwiga Provincial Clinical Hospital, Rzeszow, Poland.
⁴ Medical College, Rzeszów University, Poland.
⁵ Department of Anaesthesiology and Intensive Care, Department of Clinical Anaesthesiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

Abstract

Introduction: Working on the institutional Enhanced Recovery After Surgery (ERAS Cardio) protocol for off-pump coronary artery bypass graft surgery (OP-CABG) we have noticed that patients treated according to the modified anesthesia protocol had not only significantly shorter time of respiratory support and intensive care unit stay but also lower postoperative troponin T concentration than patients who had standard fentanyl/sevoflurane-based anesthesia.

Aim: To compare the perioperative course of patients undergoing OP-CABG surgery and receiving standard fentanyl/sevoflurane anesthesia and those anesthetized according to the institutional ERAS Cardio protocol with remifentanil, sevoflurane, and bilateral extensor spinae plane (ESP) block.

Material and methods: Design: a prospective, open-label, observational study performed in a tertiary health center. Participants: 30 consecutive patients undergoing off-pump coronary bypass graft surgery. Interventions: 15 patients had standard anesthesia with etomidate, fentanyl, and rocuronium for induction and fentanyl/sevoflurane for maintenance (standard group); 15 others had bilateral single shot ESP block, then etomidate, remifentanil and rocuronium for induction, and remifentanil/sevoflurane for maintenance of anesthesia.

Results: Median time to extubation was 7.6 (5.5-12.5) h and 1.7 (1-3.25) h in "standard care" and ERAS groups, respectively (p = 0.00002). Length of stay in the intensive care unit was also shorter for patients in the ERAS group 20.5 (18-24) vs. 48 (42-48) h (p = 0.00001). Troponin concentration increased to a lesser extent in patients from the ERAS group: an increase of 151.8 (71.9-174.3) ng/ml vs. 253.8 (126.6-373.1) ng/ml, p = 0.008.

Conclusions: Remifentanil/sevoflurane anesthesia combined with bilateral ESP block shortens mechanical ventilation time and ICU stay, and decreases postoperative troponin-T concentration in patients undergoing off-pump coronary bypass graft surgery.

Keywords: coronary bypass grafting; fentanyl; nerve block; off pump; remifentanil; troponin T.