International Society For Minimally Invasive Cardiothoracic Surgery

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Erector Spinae Plane Block To Promote Enhanced Recovery In Minimally Invasive Coronary Artery Bypass Surgery
Jef Van den Eynde1, Danny Hoogma2, Steffen Rex2, Filip Rega1, Herbert De Praetere1, Wouter Oosterlinck1.
1Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium, 2Department of Cardiovascular Diseases, Research Unit of Anesthesiology and Algology, University Hospitals Leuven, Leuven, Belgium.

Objective: Adequate analgesia is paramount for Enhanced Recovery After Surgery (ERAS). The use of the erector spinae plane block (ESP) in Robotic Assisted Minimally Invasive Direct Coronary Artery Bypass (RA-MIDCAB) has not yet been investigated. The aim of this retrospective study was to perform a preliminary analysis of the effects of ESP in RA-MIDCAB on postoperative pain and recovery. Methods: We studied 24 patients that underwent fast-track RA-MIDCAB surgery between October 2017 and November 2018. Next to intravenous multimodal analgesia, one group (n=8) received ESP (Figure 1), while another group (n=16) received local wound infiltration and served as control. The following parameters were collected: postoperative morphine consumption in the post anesthesia care unit (PACU), need for analgesics at the ward, numerical rating score for pain (NRS), incidence of post-operative nausea and vomiting (PONV), length of stay, oxygen saturation, respiratory rate, need for a thorax drainage, and the occurrences of pneumothorax, pneumonia, pericarditis, treatment for pericarditis, delirium and atrial fibrillation. Data are presented as mean SD or n (%). Results: Patients with ESP compared to control required less intravenous morphine at the PACU (5.9 4.5 mg vs 14.3 8.3 mg, p=0.004) and during the total stay (33 11.5 mg vs 44.6 13.8 mg, p=0.045). NRS for pain after extubation was lower (2.5 2.3 vs 4.8 2.6, p=0.048), as was the area under the curve of all NRS scores (405 421 vs 787 584, p=0.016) and the average NRS (1.74 0.98 vs 2.82 0.98, p=0.013). ESP was also associated with a reduction in PONV incidence [0 (0.0%) vs 6 (37.5%), p=0.046]. Conclusions: ESP was associated with less morphine use, lower NRS scores and a reduction in PONV. These results suggest an important role for ESP in facilitating ERAS in RA-MIDCAB surgery.
LEGEND: Figure 1. ESP block. A, Ultrasound image following injection of local anesthetic showing the needle (white arrows) being advanced through the trapezius (TM), rhomboid major (RMM), and erector spinae muscle (ESM) towards the intervertebral space below the transverse process of T5 (TP5). B, Patient positioned for ESP block.

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