Bilateral Erector Spinae Blocks Decrease Perioperative Opioid Use After Pediatric Cardiac Surgery

Summary: Prospective cohort (pilot) study of 10 patients aged 5-17 years having elective primary cardiac surgery, with 20 controls matched for age, sex and diagnosis. Bilateral ESPB catheters performed at completion of surgery. Time to perform block measured (median time 16min), and oral equivalent morphine dose calculated for 1st 48 hours (10% reduction in ESPB group).

Commentary: The primary aim was to demonstrate the feasibility of performing a bilateral catheter-based ESPB at the conclusion of surgery. The study included only patients aged 5-17 years for primary (i.e., not redo) cardiac surgery, a very small subset of paediatric cardiac patients. The median time to complete the block procedure of 16min would be feasible in many settings, although performing the block after surgery may be problematic. The reduction in 48-hour oral morphine equivalent opioid dose that was demonstrated was approximately 10%. 0.9 vs 1.05mg/kg/48hrs (~7mcg/kg/hr IV morphine equivalent). It may be that the previously implemented ERAS program (which both groups of patients were drawn from) may have already significantly reduced opioid requirements, making further reduction difficult to achieve. The authors state that larger studies are planned to better assess the size of the opioid sparing effect, as well as the timing (before surgery?) to optimise reduction in peri-operative stress.

Reviewed by Dr Ian Miles