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

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Supplementary files

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

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3. 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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4. 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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5. Fig. 4. Fentanyl consumption per operation.

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6. Fig. 5. Duration of extended ventilation.

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