Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: A prospective randomized controlled trial.

Abstract

Many analgesic modalities have been investigated in pediatrics. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in pediatric patients undergoing open midline splenectomy. Sixty patients aged 3-10years were randomly assigned into two groups: Control group received general anesthesia with bilateral sham erector spinae plane block using 0.3mL/kg normal saline on each side. Erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block using 0.3mL/kg bupivacaine 0.25% (on each side) with a maximum dose of 2mg/kg. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), total consumption of intraoperative fentanyl (1µg/kg IV in case of inadequate analgesia), time to first rescue analgesic administration, and postoperative paracetamol consumption were recorded over the first 24hours postoperatively. The median (IQR) postoperative CHEOPS score at 1hour was lower in erector spinae plane block group (5.0 (4.75 -5.25)) than the control group (7.0 (6.0-10.0)) (P<.001, 95% CI: 1.0; 5.0). The CHEOPS scores for the first eight postoperative hours were lower in the erector spinae plane block group (5.0 (5.0-6.0)) than the control group (6.0 (6.0 -10.0)) (P˂.001, 95% CI: 1.0; 2.0). Intraoperative fentanyl administration was higher in the control group 40.0 (21.5-50.0)μg compared to erector spinae plane block group 0.0 (0.0-0.0) μg (P˂.001, 95% CI: 23.0; 48.0). The total postoperative paracetamol consumption was higher in the control group (37.5±17.1mg/kg) compared to erector spinae plane block group (8.5±10.9mg/kg) (P˂.001, 95% CI: 21.57; 36.43). The time to the first postoperative rescue analgesic requirement was longer in the erector spinae plane block group. Ultrasound-guided erector spinae plane block reduced CHEOPS score for the first eight hours postoperatively with the reduction of intraoperative fentanyl and postoperative paracetamol consumptions.