Abstract
This study tested the hypothesis that continuous bilateral erector spinae plane blocks placed preoperatively would reduce opioid consumption and improve outcomes compared with standard practice in open cardiac surgery patients. Patients who received bilateral continuous erector spinae plane blocks for primary open coronary bypass, aortic valve, or ascending aortic surgery were compared to a historical control group. Patients in the block group received a 0.5% ropivacaine bolus preoperatively followed by a 0.2% ropivacaine infusion begun postoperatively. No other changes were made to the perioperative care protocol. The primary outcome was opioid consumption. Secondary outcomes were time to extubation and length of stay. Twenty-eight patients received continuous erector spinae plane blocks and fifty patients served as historic controls. Patients who received blocks consumed less opioids, expressed as oral morphine equivalents, both intraoperatively (34 ± 17 vs. 224 ± 125 mg) and during their hospitalization (224 ± 108 vs. 461 ± 185 mg). Patients who received blocks had shorter times to extubation (126 ± 87 vs. 257 ± 188 min) and lengths of stay in the intensive care unit (35 ± 17 vs. 58 ± 42 h) and hospital (5.6 ± 1.6 vs. 7.7 ± 4.6 days). Continuous erector spinae plane blocks placed prior to open cardiac surgical procedures reduced opioid consumption, time to extubation, and length of stay compared to a standard perioperative pathway.
Highlights
Open cardiac procedures historically relied upon large doses of opioids to provide hemodynamic stability during surgery and analgesia in the postoperative period [1]
While opioids are useful for their analgesic effect, their use is associated with adverse events that can harm patients and increase the cost of care and length of stay (LOS) [2]
The retrospective intervention group was composed of patients who received preoperative continuous erector spinae plane (ESP) blocks for open cardiac surgery by two surgeons between 21 June 2019, and 30 October 2019
Summary
Open cardiac procedures historically relied upon large doses of opioids to provide hemodynamic stability during surgery and analgesia in the postoperative period [1]. Opioid analgesia puts patients at risk for developing long-term persistent use after discharge, further increasing morbidity from opioid therapy [3]. The risk for persistent use after cardiac surgery is even higher, averaging 8% in patients following coronary artery bypass grafting [4]. As the risks of opioid therapy are dose related [2,4], reducing opioid consumption in the perioperative period should, in theory, improve patient outcomes [5,6]. Must be accomplished without compromising analgesia since higher levels of pain in the postoperative period place patients at risk for developing chronic pain syndromes [7]
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