Zabani Ibrahim A, Alamoudi Dareen, Alhroub Khalid, Alhassoun Abdulkareem, Tawfik Gamal, Alzanbagi Adel, Alzahrani Faisal, Zia Faizan, Almuqati Reem, Tayeb Abdullah, Alsayouri Zakaria, Saad Hasan
Departments of Anesthesiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Saudi J Anaesth. 2025 Jul-Sep;19(3):327-333. doi: 10.4103/sja.sja_662_24. Epub 2025 Jun 16.
Post-sternotomy pain is a significant challenge in cardiac surgeries. Effective pain management can reduce opioid reliance and lower pain scores, contributing to shorter hospital stays. The erector spinae plane block (ESPB) has shown promise as an analgesic for various surgical procedures. Given the frequency of sternotomies in our center and the associated prolonged pain that delays intensive care unit (ICU) discharge, we aimed to assess the impact of ESPB on postoperative opioid (fentanyl) use and pain levels up to 48 h after extubation.
This study was a prospective, double-blind, randomized controlled trial involving 80 adult patients (ASA III) scheduled for cardiac surgery. Participants were randomized into two groups: the ESPB group ( = 40; bilateral 0.25% bupivacaine, 20 mL) and a control group ( = 40; no ESPB). The main outcomes measured were fentanyl use post-surgery and pain scores using the visual analog scale (VAS). Secondary outcomes included intraoperative fentanyl use, time to first analgesic dose, extubation timing, and ICU stay duration. SPSS v.26 was used for statistical analysis.
The ESPB group had significantly reduced fentanyl consumption during intubation (150 [0-800] vs. 950 [30-5260], < 0.0001), at 3 h post-extubation (25 [0-50] vs. 0 [0-200], = 0.034), 12 h post-extubation (0 [0-80] vs. 0 [0-200], = 0.002), over 12 h total (0 [0-100] vs. 30 [0-600], = 0.01), at 24 h (0 [0-100] vs. 30 [0-900], = 0.003), and at 48 h (0 [0-100] vs. 50 [0-1200], = 0.001). VAS scores were consistently lower for the ESPB group at rest at multiple points up to 48 h ( < 0.0001). Additionally, the ESPB group required less intraoperative fentanyl ( = 0.001), had shorter ICU stays ( = 0.009), and faster extubation times ( = 0.013). The time to first analgesic and paracetamol use did not differ significantly ( = 0.97 and 0.255, respectively).
The findings suggest that ESPB is an effective addition to multimodal anesthesia for cardiac surgery, significantly reducing pain and opioid use, and improving postoperative outcomes.
胸骨切开术后疼痛是心脏手术中的一项重大挑战。有效的疼痛管理可减少对阿片类药物的依赖并降低疼痛评分，有助于缩短住院时间。竖脊肌平面阻滞（ESPB）已显示出有望成为各种外科手术的一种镇痛方法。鉴于我们中心胸骨切开术的频率以及与之相关的导致重症监护病房（ICU）出院延迟的长期疼痛，我们旨在评估ESPB对拔管后长达48小时的术后阿片类药物（芬太尼）使用和疼痛水平的影响。
本研究是一项前瞻性、双盲、随机对照试验，纳入了80例计划进行心脏手术的成年患者（ASA III级）。参与者被随机分为两组：ESPB组（n = 40；双侧0.25%布比卡因，20 mL）和对照组（n = 40；不进行ESPB）。主要测量的结局指标是术后芬太尼使用情况和采用视觉模拟量表（VAS）的疼痛评分。次要结局指标包括术中芬太尼使用情况、首次给予镇痛剂的时间、拔管时间和ICU住院时长。使用SPSS v.26进行统计分析。
ESPB组在插管期间（150 [0 - 800] vs. 950 [30 - 5260]，P < 0.0001）、拔管后3小时（25 [0 - 50] vs. 0 [0 - 200]，P = 0.034）、拔管后12小时（0 [0 - 80] vs. 0 [0 - 200]，P = 0.002）、12小时总时长（0 [0 - 100] vs. 30 [0 - 600]，P = 0.01）、24小时（0 [0 - 100] vs. 30 [0 - 900]，P = 0.003）以及48小时（0 [0 - 100] vs. 50 [0 - 1200]，P = 0.001）的芬太尼消耗量均显著降低。在长达48小时的多个时间点，ESPB组静息时的VAS评分持续较低（P < 0.0001）。此外，ESPB组术中所需芬太尼较少（P = 0.001），ICU住院时间较短（P = 0.009），拔管时间更快（P = 0.
