Effectiveness of erector spinae plane block in children with pectus excavatum deformity during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex: a prospective randomized comparative study

BACKGROUND: Despite the widespread use of regional blocks in children, ensuring adequate perioperative pain control during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex remains a problem. The introduction of ultrasound navigation has allowed specialists to increasingly give preference to peripheral blockades; paravertebral anesthesia has proven to be effective in thoracic surgery. However, safer interfascial blocks, including erector spinae plane block, are rarely used in pediatrics, and there is no evidence base for the effectiveness of the method.

OBJECTIVE: Our aim was to compare the effectiveness of erector spinae plane block with paravertebral blockade during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex in children.

MATERIALS AND METHODS: A prospective randomized comparative study of children who underwent minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex was conducted from September 2022 to April 2023. According to the inclusion criteria, the selected 39 children were divided into groups: I — paravertebral blockade, and II — erector spinae plane block. The mean arterial pressure, heart rate during the perioperative period stages, postanesthesia recovery by Aldrete scale and pain intensity by the Wong–Baker scale, and stress response markers (cortisol and lactate) were assessed.

RESULTS: No significant differences were observed in the study groups when comparing mean arterial pressure and heart rate at any of the measurement points of the perioperative period (p >0.05). Further, no significant differences were noted between the groups when comparing cortisol and lactate levels (p >0.05). The awakening level was characterized by a short recovery period and did not differ between the groups (p >0.05). The intensity of pain during the observation period did not exceed 5 points on the verbal rating scale in both groups, and the severity of pain was significantly higher in the group with blockade of the erector spinae plane block only 2 hours after surgery (p <0.05).Postoperative nausea and vomiting were more common in children with erector spinae plane block (p >0.05). No other adverse events were recorded.

CONCLUSION: Erector spinae plane block is an effective and simple method of regional anesthesia for minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex and can be used as an alternative to paravertebral blockade in children.