Ebru CANAKCİ, Nilay TAŞ, Aysenur KİRDEMİR, Ismail ELMALİ, Melih ÜRKMEZ

Comparison of Bilateral Erector Spinae Plane Block and Thoracic Epidural Analgesia in Open Heart Surgery

Objective: In our study, it was aimed to compare the postoperative analgesic efficacy of bilateral USG-guided erector spinae plane block (ESP) block and thoracic epidural analgesia (TEA) in patients who underwent open heart surgery. Methods: No interventional multimodal analgesia technique was applied to the patients in the control group, only iv patient-controlled analgesia (iv PCA) device was inserted at the end of the operation. The duration of postoperative mechanical ventilation (MV), the amount of opioid consumed in the first 24 hours, and the visual analog scale (VAS) scores during postoperative 1st, 2nd, 4th, 6th, 12th, 24th hours while resting/coughing were recorded. Results: There was a notable difference there among the groups in terms of the amount of postoperative opioid consumption (p=0.001). There was a notable difference there among the groups in the resting VAS scores at the postoperative 1st, 2nd, 4th, 12th, and 24th hours (p<0.001, p=0.002, p=0.002, p=0.051, p=0.001, p=0.021 respectively). There was a notable difference there among the groups in the VAS scores while coughing at the postoperative 1st, 2nd, 4th, 6th, and 24th hours (p<0.001, p<0.001, p<0.001 p=0.008, p=0.051, p=0.006 respectively). Conclusion: We think that ESP block is a good alternative to TEA, which is shown as the gold standard in pain control after open heart surgery

Keywords:

Erectors pinae plane block, thoracic epidural analgesia, postoperative analgesia management,

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Nalysnyk L, Fahrbach K, Reynolds MW, Zhao SZ, Ross S. Adverseevents in coronaryartery bypass graft (CABG) trials: a systematic review and analysis. Heart(British Cardiac Society). 2003:1;89(7):767–72.
Bigeleisen PE, Goehner N. Novel approaches in pain management in cardiacsurgery. CurrentOpinion in Anaesthesiology. 2015;28(1):89–94.
Kehlet H, Jensen TS, Woolf CJ. Persistent post surgical pain: risk factors and prevention. The Lancet. 2006:1;367(9522):1618–25.
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7,
Forero M, Rajarathinam M, Adhikary S, Chin KJ. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: A Case Rep. A&A Practise 2017;8(10):254–56.
Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: A report of 3 cases. Reg Anesth Pain Med 2017; 42(3):372–76.
Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N et al. Comparison ofcontinuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018;21(3):323-27. doi: 10.4103/aca.ACA_16_18. PMID: 30052229; PMCID: PMC6078032.
Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. Journal of Clinical Anesthesia. 2018;50(1):65- 68.
Chin KJ, Adhikary S, Sarwani N, Forero M. Theanalgesicefficacy of pre‐ operativebilateralerectorspinaeplane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 72(4);452-460, 2017.
Marshall K, McLaughlin K. Pain Management in Thoracic Surgery. Thorac Surg Clin. 2020;30(3):339-346. doi: 10.1016/j.thorsurg.2020.03.001.
Kirnö K, Friberg P, Grzegorczyk A,Milocco I,Ricksten SE,Lundin S. Thoracic epidural anesthesia during coronary artery bypass surgery: Effects on cardiac sympathetic activity, myocardial blood flow and metabolism, and central hemodynamics. Anesth Analg. 1994; 79(6):1075-81.
Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side effects of paravertebral vs epidural blockade for thoracotomy-a systematic review and metaanalysis of randomized trials. Br J Anaesth 2006;96(4):418–26.
Royse C, Royse A, Soeding P. Prospective randomized trial of high thoracic epidural analgesia for coronary artery bypass surgery. Ann Thorac Surg 2003; 75(1):93-100
Erturk, E, Aydogdu Kaya F, Kutanis D, Besir A, Akdogan A, Geze S et al. The effectiveness of preemptive thoracic epidural analgesia in thoracic surgery. Bio Med Research International 2014; Article ID:673682 pp:1-6
Piskin O, Gokce M, Altınsoy B, Baytar C, Aydın BG, Okyay RD et al. Effects of continuous erector spinae plane block on postoperative pain in video-assisted thoracoscopic surgery: a randomized controlled study. Gen Thorac Cardiovasc Surg. 2022;70(1):64- 71. doi: 10.1007/s11748-021-01687-1.
Kukreja P, Herberg TJ, Johnson BM, Kofskey AM, Short RT, MacBeth L et al. Retrospective Case Series Comparing the Efficacy of Thoracic Epidural with Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery. Cureus. 2021;13(10):e18533. doi: 10.7759/cureus.18533.