A Novel Use of Liposomal Bupivacaine in Erector Spinae Plane Block for Pediatric Congenital Cardiac Surgery

Abstract

We describe the use of liposomal bupivacaine (Exparel) in erector spinae plane blocks for two patients undergoing pediatric cardiac surgery with cardiopulmonary bypass and one undergoing division of the compressive vascular ring. The perioperative course of all patients was remarkable for low pain and sedation scores, especially after chest tube removal. Erector spinae plane blocks are an expanding pain-control technique in both adult and pediatric cardiac surgery for postoperative analgesia. Liposomal bupivacaine offers prolonged analgesia and may be an attractive option for this indication.

The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study

“…In our study, TRLB was associated with reduced time to extubation and ICU length of stay. This is in agreement with other chest wall fascial plane blocks including bilateral erector spinae plane block [13][14][15] and transversus thoracis muscle plane block [16,17]. This can be explained by the reduction in the perioperative opioid consumption.…”

“…Recently, most anesthetists prefer the use of ultrasound-guided muscle plane blocks instead of spinal, caudal, epidural and paravertebral analgesia to avoid the probable risk of epidural hematoma after full heparinization [3,4]. Bilateral ultrasound guided erector spinae plane block [13][14][15] and transversus thoracis muscle plane block [16,17] are associated with effective postoperative analgesia after pediatric cardiac surgery. The present study is the first to use bilateral TRLB for analgesia after cardiac surgery via midline sternotomy incision.…”

Use of Liposomal Bupivacaine in Pediatric Peripheral Nerve Blocks after Traumatic Amputation

“…Adult pharmacokinetic data may suggest that the liposomal formulation could convey less toxicity than the standard formulation due to a lower peak release [ 6 ]. Our institution, a tertiary children's hospital, has explored a variety of uses, including infiltration, plane blocks (erector spinae [ 7 ], serratus anterior, transversus abdominis, and quadratus lumborum), and adductor canal blocks in teenage children, with no significant complications reported (unpublished data).…”

Commentary: X-ray vision, a superpower against postoperative pain?

“…Epidural and paravertebral blocks have been most frequently studied; however, emerging non-neuraxial truncal regional anesthetic techniques, including pectointercostal fascial blocks and erector spinae plane blocks, may offer similar analgesic benefits with reduced complication potential, especially in the setting of systemic anticoagulation. 2 , 3 , 4 , 5 , 6 This reduced risk profile underscores the need to demonstrate a benefit to patients rather than merely reporting the absence of adverse of events.…”