Technique, safety, efficacy, and optimal drug volume for erector spinae plane block in neonatal and infant cardiac surgery: A single-center experience with 295 cases

Introduction: The erector spinae plane block (ESPB) is an emerging regional anesthesia technique gaining popularity for perioperative pain management in pediatric cardiac surgery. However, limited data exist on the feasibility, safety, hemodynamic stability, and efficacy of ESPB in neonates and infants undergoing cardiac procedures. This study aimed to evaluate the procedural safety, optimal drug volume, and its impact on ventilation duration, intensive care unit (ICU) length of stay (LOS), and opioid consumption in neonates and infants undergoing complex heart surgeries. Methods: Conducted at a tertiary pediatric cardiac center in Southern India from January 2021 to June 2023, this study included 295 infants (≤1 year) who received ESPB. These patients were compared with an equal number of neonates and infants who underwent cardiac surgery before ESPB implementation. Data were retrospectively reviewed from the International Quality Improvement Collaborative for Congenital Heart Disease and hospital records. Results: No procedure-related complications or intraoperative hemodynamic instability were observed in the ESPB group. The modified technique was easily administered, requiring 1 ml/kg for each hemithorax to achieve effective analgesia. The ESPB group showed significantly lower cumulative opioid consumption (400 [100–400] µg) compared to the pre-ESPB group (600 [250–600] µg). In addition, the duration of invasive mechanical ventilation was shorter (20 [11–43] h vs. 23 [16–43] h), and ICU LOS was reduced (72 [48–120] h vs. 96 [72–168] h). Conclusions: ESPB is a safe, feasible, and effective option for perioperative analgesia in neonates and infants undergoing cardiac surgery. Administering a volume of 1 ml/kg on each thorax provides optimal analgesia, reducing opioid use, invasive ventilation duration, and ICU LOS.