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Bilateral Ultrasound-Guided Erector Spinae Plane Block for Pectus Excavatum Surgery: A Retrospective Propensity-Score Study

Published:August 26, 2022DOI:https://doi.org/10.1053/j.jvca.2022.08.018
      Objective: Pectus excavatum (PE) repair is burdened by severe postoperative pain. This retrospective study aimed to determine whether the analgesic effect of ultrasound-guided erector spinae plane block (ESPB) plus standard intravenous analgesia (SIVA) might be superior to SIVA alone in pain control after PE surgical repair via Ravitch or Nuss technique.
      Design: A retrospective cohort study.
      Setting: At a university hospital.
      Participants: All participants were scheduled for surgical repair of PE.
      Interventions: From January 2017 to December 2019, all patients who received ESPB plus SIVA or SIVA alone were investigated retrospectively. A 2:1 propensity-score matching analysis considering preoperative variables was used to compare analgesia efficacy in 2 groups. All patients received a 24-hour continuous infusion of tramadol, 0.1 mg/kg/h, and ketorolac, 0.05 mg/kg/h, via elastomeric pump, and morphine, 2 mg, intravenously as a rescue drug. The ESPB group received preoperative bilateral ESPB block. Postoperative pain, reported using a numerical rating scale at 1, 12, 24, and 48 hours after surgery; the number of required rescue doses; total postoperative morphine milligram equivalents consumption; and the incidence of postoperative nausea and vomit were analyzed.
      Measurement and Main Results: A total of 105 patients were identified for analysis. Propensity-score matching resulted in 38 patients in the SIVA group and 19 patients in the ESPB group. Postoperative pain, the number of rescue doses, and postoperative nausea and vomit incidences were lower in the ESPB group (p < 0.005).
      Conclusions: Erector spinae plane block may be an effective option for pain management after surgical repair of PE as part of a multimodal approach. This study showed good perioperative analgesia, opioid sparing, and reduced opioid-related adverse effects.

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      References

        • Fonkalsrud EW.
        Current management of pectus excavatum.
        World J Surg. 2003; 27: 502-508
        • Frantz FW.
        Indications and guidelines for pectus excavatum repair.
        Curr Opin Pediatr. 2011; 23: 486-491
        • Mavi J MD
        Anesthesia and analgesia for pectus excavatum surgery.
        Anesthesiol Clin. 2014; 32: 175-184
        • Pilegaard HK
        • Grosen K.
        Postoperative pain location following the Nuss procedure–what is the evidence and does it make a difference?.
        Eur J Cardiothorac Surg. 2010; 38: 208-209
        • Papic JC
        • Finnell SME
        • Howenstein AM
        • et al.
        Postoperative opioid analgesic use after Nuss versus Ravitch pectus excavatum repair.
        J Pediatr Surg. 2014; 49: 919-923
        • Siddiqui A
        • Tse A
        • Paul J
        • et al.
        Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: A 10-year retrospective analysis.
        Local Reg Anesth. 2016; 9: 25-33
        • Patvardhan C
        • Martinez G.
        Anaesthetic considerations for pectus repair surgery.
        J Vis Surg. 2016; 2: 76
        • Muhly WT
        • Maxwell LG
        • Cravero JP.
        Pain management following the Nuss procedure: A survey of practice and review.
        Acta Anaesthesiol Scand. 2014; 58: 1134-1139
        • St Peter SD
        • Weesner KA
        • Weissend EE
        • et al.
        Epidural vs patient-controlled analgesia for postoperative pain after pectus excavatum repair: A prospective, randomized trial.
        J Pediatr Surg. 2012; 47: 148-153
        • Weber T
        • Mätzl J
        • Rokitansky A
        • et al.
        Superior postoperative pain relief with thoracic epidural analgesia versus intravenous patient-controlled analgesia after minimally invasive pectus excavatum repair.
        J Thorac Cardiovasc Surg. 2007; 134: 865-870
        • Rawal N.
        Epidural technique for postoperative pain: Gold standard no more?.
        Reg Anesth Pain Med. 2012; 37: 310-317
        • St Peter SD
        • Weesner KA
        • Sharp RJ
        • et al.
        Is epidural anesthesia truly the best pain management strategy after minimally invasive pectus excavatum repair?.
        J Pediatr Surg. 2008; 43: 79-82
        • Hall Burton DM
        • Boretsky KR
        A comparison of paravertebral nerve block catheters and thoracic epidural catheters for postoperative analgesia following the Nuss procedure for pectus excavatum repair.
        Paediatr Anaesth. 2014; 24: 516-520
        • Archer V
        • Robinson T
        • Kattail D
        • et al.
        Postoperative pain control following minimally invasive correction of pectus excavatum in pediatric patients: A systematic review.
        J Pediatr Surg. 2020; 55: 805-810
        • Qi J
        • Du B
        • Gurnaney H
        • et al.
        A prospective randomized observer-blinded study to assess postoperative analgesia provided by an ultrasound-guided bilateral thoracic paravertebral block for children undergoing the Nuss procedure.
        Reg Anesth Pain Med. 2014; 39: 208-213
        • Loftus PD
        • Elder CT
        • Russell KW
        • et al.
        Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children.
        J Pediatr Surg. 2016; 51: 149-153
        • Forero M
        • Adhikary SD
        • Lopez H
        • et al.
        The erector spinae plane block a novel analgesic technique in thoracic neuropathic pain.
        Reg Anesth Pain Med. 2016; 41: 621-627
        • Fiorelli S
        • Leopizzi G
        • Saltelli G
        • et al.
        Bilateral ultrasound-guided erector spinae plane block for postoperative pain management in surgical repair of pectus excavatum via Ravitch technique.
        J Clin Anesth. 2019; 56: 28-29
        • Nardiello M
        • Herlitz M.
        Bilateral single shot erector spinae plane block for pectus excavatum and pectus carinatum surgery in two pediatric patients.
        Rev Esp Anestesiol Reanim. 2018; 65: 530-533
        • Yoshizaki M
        • Murata H
        • Ogami-Takamura K
        • et al.
        Bilateral erector spinae plane block using a programmed intermittent bolus technique for pain management after Nuss procedure.
        J Clin Anesth. 2019; 57: 51-52
        • Lowery DR
        • Raymond DP
        • Wyler DJ
        • et al.
        Continuous erector spinae plane blocks for adult pectus excavatum repair.
        Ann Thorac Surg. 2019; 108: e19-e20
        • Le S
        • Lo C
        • Costandi A
        • et al.
        Bilateral Erector Spinae Plane (ESP) catheters for Ravitch procedure in a pediatric patient with Harrington rods.
        J Clin Anesth. 2020; 66109925
        • Haller Jr, JA
        • Kramer SS
        • Lietman SA.
        Use of CT scans in selection of patients for pectus excavatum surgery: A preliminary report.
        J Pediatr Surg. 1987; 22: 904-906
        • Bliss DP
        • Strandness TB
        • Derderian SC
        • et al.
        Ultrasound-guided erector spinae plane block versus thoracic epidural analgesia: Postoperative pain management after Nuss repair for pectus excavatum.
        J Pediatr Surg. 2022; 57: 207-212
        • Fiorelli S
        • Leopizzi G
        • Massullo D
        • et al.
        Anesthetic management of a patient with Freeman-Sheldon syndrome in thoracic surgery.
        J Clin Anesth. 2018; 48: 48-49
        • Tore Altun G
        • Arslantas MK
        • Corman Dincer P
        • et al.
        Ultrasound-guided serratus anterior plane block for pain management following minimally invasive repair of pectus excavatum.
        J Cardiothorac Vasc Anesth. 2019; 33: 2487-2491
        • Umari M
        • Segat M
        • Lucangelo U
        Epidural for mini-invasive thoracic surgery: Do we need a sledgehammer to crack a nut?.
        J Thorac Dis. 2018; 10: S2223-S2224
        • Meyer MJ
        • Krane EJ
        • Goldschneider KR
        • et al.
        Case report: Neurological complications associated with epidural analgesia in children: A report of 4 cases of ambiguous etiologies.
        Anesth Analg. 2012; 115: 1365-1370
        • Forero M
        • Rajarathinam M
        • Adhikary S
        • et al.
        Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: A case report.
        A A Case Reports. 2017; 8: 254-256
        • Diwan S
        • Garud R
        • Nair A.
        Thoracic paravertebral and erector spinae plane block: A cadaveric study demonstrating different site of injections and similar destinations.
        Saudi J Anaesth. 2019; 13: 399-401
        • Bonvicini D
        • Boscolo-Berto R
        • De Cassai A
        • et al.
        Anatomical basis of erector spinae plane block: A dissection and histotopographic pilot study.
        J Anesth. 2021; 35: 102-111
        • Leyva FM
        • Mendiola WE
        • Bonilla AJ
        • et al.
        Continuous erector spinae plane (ESP) block for postoperative analgesia after minimally invasive mitral valve surgery.
        J Cardiothorac Vasc Anesth. 2018; 32: 2271-2274
        • Taketa Y
        • Irisawa Y
        • Fujitani T.
        Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax.
        J Clin Anesth. 2018; 47: 84-85
        • Roy N
        • Brown ML
        • Parra MF
        • et al.
        Bilateral erector spinae blocks decrease perioperative opioid use after pediatric cardiac surgery.
        J Cardiothorac Vasc Anesth. 2021; 35: 2082-2087
        • Hessian EC
        • Evans BE
        • Woods JA
        • et al.
        Plasma ropivacaine concentrations during bilateral transversus abdominis plane infusions.
        Br J Anaesth. 2013; 111: 488-495