Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study

Silvia Fiorelli; Cecilia Menna; Claudio Andreetti; Valentina Peritore; Monica Rocco; Roberto Alberto De Blasi; Erino Angelo Rendina; Domenico Massullo; Mohsen Ibrahim

doi:10.1053/j.jvca.2022.08.018

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study

J Cardiothorac Vasc Anesth. 2022 Dec;36(12):4327-4332. doi: 10.1053/j.jvca.2022.08.018. Epub 2022 Aug 27.

Authors

Silvia Fiorelli¹, Cecilia Menna², Claudio Andreetti², Valentina Peritore², Monica Rocco³, Roberto Alberto De Blasi³, Erino Angelo Rendina², Domenico Massullo³, Mohsen Ibrahim²

Affiliations

¹ Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: silvia.fiorelli@uniroma1.it.
² Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
³ Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

PMID: 36163156
DOI: 10.1053/j.jvca.2022.08.018

Abstract

Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique.

Design: A retrospective cohort study.

Setting: At a university hospital.

Participants: All participants were scheduled for surgical repair of PE.

Interventions: From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed.

Measurement and main results: A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005).

Conclusions: Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects.

Keywords: Nuss procedure; Ravitch procedure; erector spinae plane block; pectus excavatum surgery; regional anesthesia; thoracic anesthesia.

MeSH terms

Analgesics, Opioid
Funnel Chest* / surgery
Humans
Morphine Derivatives / therapeutic use
Nerve Block* / methods
Pain, Postoperative / diagnosis
Pain, Postoperative / etiology
Pain, Postoperative / prevention & control
Postoperative Nausea and Vomiting / surgery
Retrospective Studies
Ultrasonography, Interventional

Substances

Analgesics, Opioid
Morphine Derivatives