Key result
Ultrasound-guided bilateral thoracic erector spinae plane block was non-inferior to paravertebral block for postoperative analgesia, with similar 24-hour fentanyl consumption (4.9 vs 4.6 μg/kg).
Why the study?
In pediatric cardiac surgery, regional analgesia reduces opioid consumption, but the comparative effects of bilateral thoracic erector spinae plane block versus paravertebral block on pain and opioid use required evaluation.
Does ultrasound-guided bilateral thoracic ESPB provide non-inferior postoperative analgesia (measured by fentanyl consumption) compared to PVB in pediatric patients undergoing open cardiac surgery?
RCT (n=44)
Double-blind
Computer-generated random numbers
No
Does ultrasound-guided bilateral thoracic ESPB provide non-inferior postoperative analgesia (measured by fentanyl consumption) compared to PVB in pediatric patients undergoing open cardiac surgery?
Mean Difference: 0.3 (95% CI -1.35–0.804)
Absolute Event Rate: 4.9% vs 4.6%
p-value: p=0.612
In pediatric patients undergoing open cardiac surgery, ultrasound-guided bilateral thoracic ESPB is non-inferior to PVB for postoperative analgesia and requires significantly less time to perform.
ESPB warrants consideration over PVB in pediatric open cardiac surgery due to shorter performance time; extends regional anesthesia evidence in this population.
In pediatric cardiac surgery, the use of multimodal analgesia, including a regional analgesic technique reduces opioid consumption and adverse effects. Objective: This study aimed to compare the effect of the ultrasound-guided bilateral thoracic erector spinae plane block (ESPB) and paravertebral block (PVB) on postoperative pain score and opioid consumption. Methods: This is a single center randomized, controlled, double-blinded, non-inferiority study. A total of 50 eligible pediatric patients, aged 2-10 years, scheduled for elective open cardiac surgery via median sternotomy were recruited. Bilateral ultrasound-guided thoracic ESPB at T4 was performed in patients included in the ESPB group and bilateral PVB was done in patients included in the PVB group by injecting 0.25% bupivacaine 0.4mL/kg on each side. The primary end point was fentanyl consumption during the first 24 h following extubation, while the secondary endpoints were postoperative modified objective pain score (MOPS), time needed to perform the block, intraoperative fentanyl consumption, time to the first analgesic request and the incidence of mechanical complications. Results: Both ESPB and PVB similarly reduced fentanyl consumption during the first 24 h following extubation and MOPS at all time points of measurement. Intraoperative fentanyl consumption and time to first analgesic request were similar in both ESPB and PVB group. The time needed to perform the block was significantly shorter in the ESPB group than the PVB group. Mechanical complications of needle advancement did not occur in any patients. Conclusion: In pediatric patients scheduled for open cardiac surgery via median sternotomy, ultrasound-guided bilateral thoracic ESPB is non-inferior to PVB in providing postoperative analgesia in terms of opioid consumption and pain score. Moreover, ESPB is easier and its performance requires a shorter period than PVB.
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Elsharkawy et al. (2023) conducted an RCT in Pediatric cardiac surgery (n=44). Ultrasound-guided bilateral thoracic erector spinae plane block (ESPB) vs. Paravertebral block (PVB) was evaluated on Fentanyl consumption during the first 24 h following extubation (μg/kg) (MD 0.3, 95% CI -1.350 to 0.804, p=0.612). Ultrasound-guided bilateral thoracic erector spinae plane block was non-inferior to paravertebral block for postoperative analgesia, with similar 24-hour fentanyl consumption (4.9 vs 4.6 μg/kg).
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