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

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


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.

Full Text

Restricted Access

About the authors

Anatoliy V. Stukalov

Kirov Military Medical Academy

Author for correspondence.
ORCID iD: 0000-0002-3869-9043
SPIN-code: 9636-6856


Russian Federation, St. Petersburg

Roman E. Lakhin

Kirov Military Medical Academy

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

ORCID iD: 0000-0003-2990-0320

department head, anesthesiologist-resuscitator

Russian Federation, St. Petersburg

Eugene N. Ershov

Kirov Military Medical Academy

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

ORCID iD: 0000-0001-7928-2132
SPIN-code: 9213-4640

clinical resident

Russian Federation, St. Petersburg


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

Download (238KB)
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.

Download (217KB)
3. Fig. 3. Maximum dosage of norepinephrine during surgery.Note (here and in Fig. 4, 5). ESP — erector spinae plane block, ОА — general anesthesia.

Download (78KB)
4. Fig. 4. Fentanyl consumption per operation.

Download (74KB)
5. Fig. 5. Duration of extended ventilation.

Download (79KB)

Copyright (c) 2023 Eco-Vector

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies