Erector Spinae Blocks for opioid-sparing multimodal pain management after Pediatric Cardiac Surgery.

OBJECTIVE: Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate: the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery.

METHODS: Patients ages 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery (ERAS) program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the ERAS program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling.

RESULTS: Forty (40) patients receiving BESB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31-min. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalent (OME) than controls at 24-hrs (0.60±0.06 vs 0.78±0.04 mg/kg, p=0.02) and 48-hrs (1.13±0.08 vs 1.35±0.06 mg/kg, p=0.04), respectively. Both groups had low median pain scores per 12-hrs period. There was no difference in early mobilization, length of stay, and complications.

CONCLUSION: B-ESpB are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an ERAS program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.