Using the blockade of interfascial space of the erector spinae muscle (erector spinae plane block) in minimally invasive coronary bypass surgery: prospective randomized study

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Abstract

BACKGROUND: Despite the successful development of cardio-anesthesiology, no consensus exists on the preferred anesthesia method for coronary artery bypass grafting.

OBJECTIVE: To evaluate the effectiveness of perioperative analgesia in minimally invasive coronary artery bypass surgery (MIDCAB) using ultrasound-assisted blockade in erector spinae plane (ESP).

MATERIALS AND METHODS: A prospective, two-center, randomized study included 37 patients who underwent MIDCAB surgery. In group 1, before the induction of general anesthesia, an ESP block was performed; in group 2, the operation was performed only under general anesthesia.

RESULTS: The consumption of fentanyl for anesthesia differed in groups 1 (ESP block) and 2 (general anesthesia): 0.9 (0.8; 1.0) mg vs 3.0 (2.6; 3.2) mg (p <0.01). The norepinephrine dosage was higher in group 2 than in group 1: 0.18 (0.16; 0.22) mcg/kg/min vs 0.05 (0.04; 0.06) mcg/kg/min (p <0.01). Postoperatively, the pain score was lower in group 1 than in group 2, and no additional opioids were required during the first 3–4 h after extubation. Thereafter, no differences in pain scores were observed between the groups.

CONCLUSION: The use of an ESP block with a single injection of a local anesthetic is effective in reducing the total dosage of fentanyl used during surgery, dosage of norepinephrine, and mechanical ventilation and improve the quality of postoperative analgesia during MIDCAB.

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About the authors

Anatoliy V. Stukalov

Kirov Military Medical Academy

Author for correspondence.
Email: zamkom-vma@mail.ru
ORCID iD: 0000-0002-3869-9043
SPIN-code: 9636-6856

researcher

Russian Federation, St. Petersburg

Roman E. Lakhin

Kirov Military Medical Academy

Email: zamkom-vma@mail.ru
ORCID iD: 0000-0001-6819-9691
SPIN-code: 7261-9985

MD, Dr. Sci. (Med.), associate professor

Russian Federation, St. Petersburg

Evgenii Y. Garbuzov

City Hospital No. 40

Email: zamkom-vma@mail.ru
ORCID iD: 0000-0003-2990-0320

department head, anesthesiologist-resuscitator

Russian Federation, St. Petersburg

Eugene N. Ershov

Kirov Military Medical Academy

Email: zamkom-vma@mail.ru
ORCID iD: 0000-0002-9572-6802
SPIN-code: 1837-5183

MD, Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Nikolay V. Stukalov

Kirov Military Medical Academy

Email: zamkom-vma@mail.ru
ORCID iD: 0000-0001-7928-2132
SPIN-code: 9213-4640

clinical resident

Russian Federation, St. Petersburg

References

  1. Ageenko AM, Sadovoy MA, Shelyakina OV, Ovtin MA. Fast-track hip and knee arthroplasty (literature review). Traumatology and Orthopedics of Russia. 2017;23(4):146–155. (In Russ). doi: 10.21823/2311-2905-2017-23-4-146-155
  2. Zante B, Erdoes G. Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable? J Cardiothorac Vasc Anesth. 2019;33(10):2717–2718. doi: 10.1053/j.jvca.2019.04.008
  3. Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015;19(4):451–465. doi: 10.1002/ejp.567
  4. Baxter R, Squiers J, Conner W, et al. Enhanced Recovery After Surgery: A Narrative Review of its Application in Cardiac Surgery. Ann Thorac Surg. 2020;109(6):1937–1944. doi: 10.1016/j.athoracsur.2019.11.008
  5. Sidiropoulou T, Pompeo E, Bozzao A, et al. Epidural hematoma after thoracic epidural catheter removal in the absence of risk factors. Reg Anesth Pain Med. 2003;28(6):531–534. doi: 10.1016/s1098-7339(03)00388-2
  6. Niesen AD, Jacob AK, Law LA, et al. Complication rate of ultrasound-guided paravertebral block for breast surgery. Reg Anesth Pain Med. 2020;45(10):813–817. doi: 10.1136/rapm-2020-101402
  7. Dualé C, Gayraud G, Taheri H, et al. A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery. J Cardiothorac Vasc Anesth. 2015;29(4):942–949. doi: 10.1053/j.jvca.2014.11.006
  8. 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(5):621–627. doi: 10.1097/AAP.0000000000000451
  9. Hoogma DF, Rex S, Tournoy J, et al. Erector spinae plane block for minimally invasive mitral valve surgery: a double-blind, prospective, randomized placebo-controlled trial-a study protocol. BMJ Open. 2021;11(4):e045833. doi: 10.1136/bmjopen-2020-045833
  10. Glushhenko VA, Irklienko EK. Cardiovascular morbidity — one of the most vital problems of modern health care. Meditsina i organizatsiya zdravookhraneniya.2019;4(1):56–63. (In Russ).
  11. Volchkov VA, Boyarkin AA, Balandina EV, et al. Influence of inhalation and epidural anesthesia on complications after coronary artery bypass grafting. Russian Journal of Thoracic and Cardiovascular Surgery. 2019;61(6):525–531. (In Russ). doi: 10.24022/0236-2791-2019-61-6-525-531
  12. Koriachkin VA, Zabolotsky DV. Place of regional blocks in surgical anesthesia. Medicine: Theory and Practice. 2018;3(4):65–69. (In Russ).
  13. Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, et al. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019;4:9–33. (In Russ). doi: 10.21320/1818-474X-2019-4-9-33
  14. Koriachkin VA, Spasova AP, Khinovker VV. Neuropathic pain. Innovative Medicine of Kuban. 2021;2:58–64.(In Russ). doi: 10.35401/2500-0268-2021-22-2-58-64
  15. Arends S, Böhmer AB, Poels M, et al. Post-thoracotomy pain syndrome: seldom severe, often neuropathic, treated unspecific, and insufficient. Pain Rep. 2020;5(2):e810. doi: 10.1097/PR9.0000000000000810
  16. Rubinchik VE, Kasherininov IY, Bautin AE, Mazurok VA. Treatment of delirium in early postoperative cardiosurgical patients. Annals of Critical Care. 2019;(3):77–83. (In Russ). doi: 10.21320/1818-474X-2019-3-77-83
  17. Bignami E, Castella A, Pota V, et al. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol. 2018;84(4):488–503. doi: 10.23736/S0375-9393.17.12142-5
  18. Zorrilla-Vaca A, Rice D, Brown JK, et al. Sustained reduction of discharge opioid prescriptions in an enhanced recovery after thoracic surgery program: A multilevel generalized linear model. Surgery. 2022;171(2):504–510. doi:0.1016/j.surg.2021.08.039
  19. Leonov AA, Koryachkin VA, Zabolotskii DV, et al. Primenenie metodov regionarnoi anestezii v obshchekhirurgicheskoi praktike kak komponenta fast-track. 3rd All-Russian Congress with International Participation «Aktual’nye voprosy meditsiny kriticheskikh sostoyanii»; 2021 May 11–13; St. Petersburg. Moscow: OOO «Moskovskoe Kongressnoe Byuro»; 2021. P. 45–46. Available from: https://www.niioncologii.ru/news/iii_vserossiyskiy_kongress _s_mezhdunarodnym_uchastiem_aktualnye_voprosy_meditsiny_kriticheskikh_sost. Accessed: 06.02.2023. (In Russ).
  20. Svircevic V, Passier MM, Nierich AP, et al. Epidural analgesia for cardiac surgery. Cochrane Database Syst Rev. 2013;(6):CD006715. doi: 10.1002/14651858.CD006715.pub2. Update in: Cochrane Database Syst Rev. 2019;3:CD006715.
  21. Scarfe AJ, Schuhmann-Hingel S, Duncan JK, et al. Continuous paravertebral block for post-cardiothoracic surgery analgesia: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50(6):1010–1018. doi: 10.1093/ejcts/ezw168
  22. Landoni G, Isella F, Greco M, et al. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015;115(1):25–32. doi: 10.1093/bja/aev201
  23. Kelly ME, Mc Nicholas D, Killen J, et al. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J. 2018;24(1):23–27. doi: 10.1111/tbj.12831
  24. Koryachkin VA. Peripheral nerve blocks and ultrasound navigation. Regional Anesthesia and Acute Pain Management. 2020;14(1):4–5.(In Russ). doi: 10.17816/1993-6508-2020-14-1-4-5
  25. De Cassai A, Geraldini F, Carere A, et al. Complications Rate Estimation After Thoracic Erector Spinae Plane Block. J Cardiothorac Vasc Anesth. 2021;35(10):3142–3143. doi: 10.1053/j.jvca.2021.02.043
  26. Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020;59:84–88. doi: 10.1016/j.jclinane.2019.06.036

Supplementary files

Supplementary Files
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1. Fig. 2. Study scheme.Note. ESP — erector spine plane, ОА — general anesthesia.

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2. Fig. 2. Ultrasound picture of the musculoskeletal-ligamentous complex of the back.Note. TR — trapezius muscle, R — rhomboid muscle, ES — erector spine muscle, TP — transverse process, P — pleura, N — needle.

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3. Fig. 3. Maximum dosage of norepinephrine during surgery.Note (here and in Fig. 4, 5). ESP — erector spinae plane block, ОА — general anesthesia.

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4. Fig. 4. Fentanyl consumption per operation.

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5. Fig. 5. Duration of extended ventilation.

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