Abstract
BackgroundEffective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital.To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks.MethodsThis was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry.ResultsPatients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6–16] mg vs. 20 [IQR: 18–29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry.ConclusionsThe addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/tricuspid valve repair via mini-thoracotomy.Trial registrationThe study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485.
Highlights
Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery
None of the patients reported any pain at the Patient satisfaction with pain management Patients in the pectoralis nerve (PECS) + erector spinae plane (ESP) group were more satisfied with pain management, compared with patients in the ESP group: 4 [interquartile range (IQR): 4–4] vs. 3 [IQR: 1–4] (p = 0.0007)
The results of the current study showed that the inclusion of an additional regional anesthesia technique (PECS I + PECS II blocks) with the ESP block significantly reduced oxycodone consumption and alleviated postoperative pain severity measured on the visual analog scale (VAS) (Figs. 6 and 7)
Summary
Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks. Among many regional anesthesia techniques for patients undergoing cardiac surgery, thoracic epidural analgesia (TEA) is associated with reduced incidences of cardiovascular events and infections, lower cost, and shortened length of hospital stay [5,6,7]. Novel fascial blocks, including the erector spinae plane (ESP) block and pectoralis nerve (PECS) block, have been recently proposed as effective methods of pain management for patients undergoing cardiac surgery [11, 12]
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