To evaluate the analgesic effectiveness of bilateral erector spinae plane block versus thoracic epidural analgesia in open cardiac surgeries approached through midline sternotomy

Hilal Ahmad Bhat; Talib Khan; Arun Puri; Jatin Narula; Altaf Hussain Mir; Shaqul Qamar Wani; Hakeem Zubair Ashraf; Suhail Sidiq; Saima Kabir

doi:10.1186/s44158-024-00148-4

To evaluate the analgesic effectiveness of bilateral erector spinae plane block versus thoracic epidural analgesia in open cardiac surgeries approached through midline sternotomy

J Anesth Analg Crit Care. 2024 Mar 1;4(1):17. doi: 10.1186/s44158-024-00148-4.

Authors

Hilal Ahmad Bhat¹, Talib Khan^{2

3}, Arun Puri⁴, Jatin Narula⁵, Altaf Hussain Mir^{1

6}, Shaqul Qamar Wani⁷, Hakeem Zubair Ashraf⁸, Suhail Sidiq⁹, Saima Kabir¹

Affiliations

¹ Department of Anaesthesiology, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.
² Department of Anaesthesiology, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India. drtalibkhan@hotmail.com.
³ Division of CardioVascular & Thoracic Anaesthesia and Cardiothoracic Surgical Intensive Care Unit, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India. drtalibkhan@hotmail.com.
⁴ Department of Anaesthesiology and Pain Management, Max Super-Specialty Hospital Patparganj, New Delhi, 110091, India.
⁵ Department of Cardiac Anaesthesia, Amrita Hospital, Faridabad, Haryana, 121002, India.
⁶ Division of CardioVascular & Thoracic Anaesthesia and Cardiothoracic Surgical Intensive Care Unit, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.
⁷ Department of Radiation Oncology, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.
⁸ Department of Cardiovascular and Thoracic Surgery, Sher I Kashmir Institute of Medical Sciences (SKIMS), Jammu and Kashmir, Srinagar, 190011, India.
⁹ Department of Critical Care Medicine, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.

Abstract

Background: The efficacy of the erector spinae plane (ESP) block in mitigating postoperative pain has been shown for a range of thoracic and abdominal procedures. However, there is a paucity of literature investigating its impact on postoperative analgesia as well as its influence on weaning and subsequent recovery in comparison to thoracic epidural analgesia (TEA) in median sternotomy-based approach for open-cardiac surgeries and hence the study.

Methods: Irrespective of gender or age, 74 adult patients scheduled to undergo open cardiac surgery were enrolled and randomly allocated into two groups: the Group TEA (thoracic epidural block) and the Group ESP (bilateral Erector Spinae Plane block). The following variables were analysed prospectively and compared among the groups with regard to pain control, as determined by the VAS Scale both at rest (VAS_R) and during spirometry (VAS_S), time to extubation, quantity and frequency of rescue analgesia delivered, day of first ambulation, length of stay in the intensive care unit (ICU), and any adverse cardiac events (ACE), respiratory events (ARE), or other events, if pertinent.

Results: Clinical and demographic variables were similar in both groups. Both groups had overall good pain control, as determined by the VAS scale both at rest (VAS_R) and with spirometry (VAS_S) with Group ESP demonstrating superior pain regulation compared to Group TEA during the post-extubation period at 6, 9, and 12 h, respectively (P > 0.05). Although statistically insignificant, the postoperative mean rescue analgesic doses utilised in both groups were comparable, but there was a higher frequency requirement in Group TEA. The hemodynamic and respiratory profiles were comparable, except for a few arrhythmias in Group TEA. With comparable results, early recovery, fast-track extubation, and intensive care unit (ICU) stay were achieved.

Conclusions: The ESP block has been found to have optimal analgesic effects during open cardiac surgery, resulting in a decreased need for additional analgesic doses and eliminating the possibility of a coagulation emergency. Consequently, it presents itself as a safer alternative to the potentially invasive thoracic epidural analgesia (TEA).

Keywords: Enhanced recovery after cardiac surgery; Erector spinae plane block; Median sternotomy; Open cardiac surgeries; Perioperative analgesia; Rescue analgesia; Thoracic epidural analgesia; Visual analogue scale.