Erector spinae plane block for perioperative analgesia in cardiac surgery. Case report

Abstract

BACKGROUND AND OBJECTIVES:The anesthetic management has evolved with the use of alternative techniques that promote greater safety, quick recovery and comfort in the perioperative period. The erector spinae plane block emerges as a promising alternative that can be employed as a simple analgesic technique for thoracic analgesia, acute post-surgical, post-traumatic and chronic neuropathic thoracic pain. CASE REPORT: Female patient, 72-year-old, undergoing aortic valve replacement surgery under general anesthesia associated with an erector spinae plane block as a technique for perioperative pain management. CONCLUSION: We demonstrate with this case report that the erector spinae plane block can be a suitable option as a regional analgesia technique for cardiac surgery, used perioperatively as a regional block for multimodal analgesia. Further research and studies are needed to address its efficacy and safety for multiple cardiac and aortic surgery techniques. Keywords: Erector spinae plane block, Fast-track, Enhanced recovery after surgery. RESUMO JUSTIFICATIVA E OBJETIVOS:O manuseio anestésico evoluiu com o uso de técnicas alternativas que promovem maior segurança, rápida recuperação e conforto no período perioperatório. O bloqueio do plano eretor espinhal surge como uma alternativa promissora que pode ser empregada como uma técnica analgésica simples para analgesia torácica, dor torácica aguda pós-cirúrgica, pós-traumática e crônica neuropática. RELATO DO CASO: Paciente do sexo feminino, 72 anos, submetida à cirurgia de troca valvar aórtica sob anestesia geral asso-© Sociedade Brasileira para o Estudo da Dor ciada ao bloqueio do plano eretor espinhal, como técnica para o manuseio da dor no período perioperatório. CONCLUSÃO: O presente relato demonstrou que o bloqueio do plano eretor espinhal pode ser uma opção adequada como uma técnica de analgesia regional para cirurgia cardíaca, usada no perioperatório como um bloqueio regional para analgesia multimodal. Mais pesquisas e estudos são necessários para abordar sua eficácia e segurança para múltiplas técnicas de cirurgia cardíaca e aórtica. Descritores: Bloqueio do plano eretor espinhal, Fast-track, Recuperação aprimorada após a cirurgia.Erector spinae plane block for perioperative analgesia in cardiac surgery. Case report Br J Pain. São Paulo, 2018 oct-dec;1(4):369-71

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

“…Bilateral ESPB led to requirement of no analgesia for the first 9 hours following aortic valve-replacement surgery. 49 In a patient undergoing emergency heart surgeries, bilateral ESPB was evaluated in a randomized controlled trial and found to decrease the total rescue analgesia and opioid requirements, as well as NRS scores, in the first 12 hours and also decrease time spent intubated. 50 A patient-matched controlled before-and-after study comparing the effects of bilateral ESPB (with catheter) with thoracic epidural analgesia on postoperative pain scores, opioid requirements, and time spent intubated found that extubation times were similar, NRS scores lower at some points but on average generally similar, and the first 48 hours' morphine consumption lower in the ESPB group (40 mg vs none).…”

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study

“…Even the optimal volume of local anesthetic to be administered to obtain the ESPB has not been established yet. [ 21 22 ] There are evidence suggesting a greater paravertebral spread after injection of 30 mL of local anesthetic. [ 23 ] And, based on this finding, a 40 mL volume of 0.375% Ropivacaine was chosen in our study.…”

Comparisons of Transdermal Buprenorphine Patch versus Transdermal Fentanyl patch for postoperative analgesia in lower limb orthopedic surgery

“…The conclusions of this study are in line with Machado FC et al systematics review. 11 Our study's limitations were that we only evaluated at the efficacy of transdermal patches in postoperative patients who had just lower limb arthroscopic procedures, so additional research is needed to understand how well they work in other major surgeries. Furthermore, no individual medication dosage response curve studies were conducted.…”