Comparison of Multiple Injection Costotransverse Block and Erector Spinae Plane Block for Post-Sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective Randomized Comparative Study

Abstract

ObjectiveThe aim of this study was to evaluate efficacy of ultrasound-guided Multiple Injection Costotransverse block (MICB) and compare it with Erector spinae Plane block (ESPB) for post-sternotomy pain relief in paediatric cardiac surgical patients. DesignA prospective, randomized, double-blind, comparative study. SettingSingle-institution tertiary referral cardiac centre. ParticipantsStudy comprised of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy. InterventionsChildren were randomly allocated to 1 of the 3 groups: ESPB (Group1), MICB (Group 2) or Control (Group 3). Participants in Group 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anaesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia and fentanyl/tramadol was used for rescue analgesia. Measurements and Main ResultsModified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours post-extubation. After all exclusions, 84 patients were analysed. MOPS score was found to be significantly lower in ESPB and MICB Group compared to Control Group till 10 hours post extubation (p<0.05), with no statistically significant difference at 12th hour (p=0.2198). Total intraoperative fentanyl consumption (p=0.0005), need for fentanyl supplementation on incision (p<0.0001) and need for rescue opioid requirement in postoperative period (p=0.034) was significantly lower in both ESPB Group and MICB Group than Control Group. There was no statistically significant difference in both primary and secondary outcomes between ESPB and MICB Groups. ConclusionUltrasound guided MICB was effective and comparable to ESPB for post-sternotomy pain management in paediatric cardiac surgical patients.