Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: randomized clinical trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Postoperative pain in patients undergoing cardiac surgery via sternotomy (n=54). Intervention: Bilateral ultrasound-guided erector spinae muscle plane block (ESPB) with ropivacaine plus multimodal general anesthesia vs. Multimodal general anesthesia alone (no nerve block). Primary outcome: Total rescue morphine consumption in the first 24 postoperative hours (mg) (p=0.779).

Q: What does this research mean for the field?

Bilateral erector spinae plane block reduces pain scores and morphine consumption during the first 6 hours after cardiac surgery but does not significantly reduce total 24-hour morphine consumption compared to multimodal general anesthesia alone. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Larissa Martins Silva; Amanda Jiran Ferreira Marcos Brandão; Jhonson Tizzo Godoy; W Leao; Juliana Faria de Freitas; Magda Lourenço Fernandes

doi:10.1016/j.bjane.2022.06.006

July 7, 2022Brazilian Journal of Anesthesiology (English Edition)Open Access

Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: randomized clinical trial

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Key result

Bilateral erector spinae plane block lowered pain and opioid use at 6 hours after cardiac surgery, though 24-hour median morphine consumption did not differ vs control.

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Why the study?

Does adding a bilateral erector spinae muscle plane block to multimodal general anesthesia reduce postoperative pain scores and rescue morphine consumption in patients undergoing cardiac surgery via sternotomy?

Key Points

To evaluate the postoperative analgesic efficacy and opioid-sparing effect of ultrasound-guided erector spinae plane block combined with multimodal general anesthesia in patients undergoing cardiac surgery.
Randomized, controlled, blinded clinical trial (Brazilian Clinical Trials Registry RBR-9djgjv) evaluating 54 analyzed patients (aged 18 to 75 years) scheduled for cardiac surgery via sternotomy.
Patients were randomized to receive preoperative bilateral ultrasound-guided erector spinae plane block with 20 mL of 0.5% ropivacaine at T4–T6 plus multimodal general anesthesia (n=25) or multimodal general anesthesia alone (n=29).
Visual Analogue Scale pain scores and morphine consumption were significantly lower in the block group up to the 6th postoperative hour, with no significant differences observed at the 12th or 24th postoperative hours.
Total 24-hour morphine consumption did not differ significantly between groups, with a median of 3 mg in the block group versus 5 mg in the control group (range 0 to 18 mg; p=0.779 by the Mann-Whitney Test).
No block-related complications were reported.

Study Design

Type

RCT (n=54)

Blinding

Single-blind (blinded outcome examiner)

Randomization

Randomly allocated using a table of random numbers

Multicenter

No

Structured PICO

Does adding a bilateral erector spinae muscle plane block to multimodal general anesthesia reduce postoperative pain scores and rescue morphine consumption in patients undergoing cardiac surgery via sternotomy?

P

Population

54 adults aged 18 to 75 years undergoing elective cardiac surgery via sternotomy, followed for 24 hours postoperatively.

I

Intervention

Bilateral ultrasound-guided erector spinae muscle plane block (ESPB) at T4-T6 level with 20 mL of 0.5% ropivacaine bilaterally before anesthetic induction (under dexmedetomidine sedation), combined with multimodal general anesthesia (remifentanil, dexmedetomidine, etomidate, cisatracurium, isoflurane, ketamine, magnesium sulfate, and sevoflurane).

C

Comparator

Multimodal general anesthesia alone (remifentanil 0.1-0.5 mcg/kg/min, dexmedetomidine 0.1-0.3 mcg/kg/h, etomidate 0.1-0.2 mg/kg, cisatracurium 0.15 mg/kg, isoflurane up to 2%, ketamine 0.1-0.3 mg/kg, magnesium sulfate 20-30 mg/kg, and sevoflurane) with no nerve block performed.

O

Outcome

Postoperative analgesia efficacy assessed by Visual Analogue Scale (VAS) pain scores (at 6th, 12th, and 24th postoperative hours by a blinded examiner) and rescue morphine consumption (up to 6th, 6th-12th, 12th-24th, and total 24-hour consumption).patient reported

Main Result

Absolute Event Rate: 3% vs 5%

p-value: p=0.779

Adding a single-shot bilateral erector spinae plane block to multimodal general anesthesia improves early postoperative pain and reduces opioid requirements up to 6 hours after cardiac surgery via sternotomy, without reducing total 24-hour morphine consumption.

Limitations

Probable interference of multimodal general anesthesia on morphine consumption resulting in low morphine consumption in both groups
Did not measure robust clinical outcomes such as mortality
15 of 74 eligible patients (9 in block group, 6 in control group) were excluded due to loss to follow-up
Probable interference of multimodal general anesthesia on morphine consumption, resulting in low morphine consumption in both groups
Loss during follow-up of 15 eligible patients (9 from block group and 6 from control group)

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Implication

May support early analgesia after sternotomy; extends RCT evidence for ESP blocks but leaves 24-hour opioid reduction unproven.

Abstract

Figure 1 Comparison between control group and erector spinae muscle plane block group regarding, (A) pain score at 6 th postoperative hour, and (B) morphine consumption up to the 6 th postoperative hour, for patients submitted to cardiac surgery.

Discussion

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Cite This Study

Silva et al. (2022) conducted an RCT in Postoperative pain in patients undergoing cardiac surgery via sternotomy (n=54). Bilateral ultrasound-guided erector spinae muscle plane block (ESPB) with ropivacaine plus multimodal general anesthesia vs. Multimodal general anesthesia alone (no nerve block) was evaluated on Total rescue morphine consumption in the first 24 postoperative hours (mg) (p=0.779). Bilateral erector spinae plane block lowered pain and opioid use at 6 hours after cardiac surgery, though 24-hour median morphine consumption did not differ vs control.

synapsesocial.com/papers/6a78c31898f24dbf64bddec0 https://doi.org/10.1016/j.bjane.2022.06.006

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Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: randomized clinical trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: randomized clinical trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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