Erector spinae plane block complementary analgesic to enhance recovery after cardiac surgery: A prospective double-blinded randomized controlled trial.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.