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

Abstract

Aims: Chest wall blocks are effective alternatives for postoperative pain control in mitral valve surgery in right mini-thoracotomy (mini-MVS). We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief after mini-MVS. Settings and Design: It is a prospective, observational study. Material and Methods: A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini-MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator-free days). Results: The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups ( P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group ( P = 0.002 and P = 0.048, respectively). Conclusions: ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

“…SAPB was found to be comparable 194 to ESPB as well as inferior 202 to PVB at decreasing opioid consumption after MICS (category B2-E evidence). 194,202 Anterior Chest Wall Technique Parasternal Block. Literature Findings.…”

“…Continuous ESPB provided comparable analgesia to continuous serratus anterior plane block (SAPB) after MICS surgery (category B2-E evidence). 194 A recent study reported that the risks associated with perioperative ESPB and SAPB block use were not increased in patients undergoing cardiopulmonary bypass or receiving postoperative anticoagulation (category B2-B evidence). 195 A case of Harlequin syndrome was reported 5 hours after a bilateral ESPB with liposomal bupivacaine (LB) before partial sternectomy (category B3 evidence).…”

“…Continuous ESPB provided comparable analgesia to continuous serratus anterior plane block (SAPB) after MICS surgery (category B2-E evidence). 194…”

Regional anesthesia in cardiac surgery and electrophysiology procedures

“…The continuous SAPB group used a minimal amount of rescue opioid while maintaining comparable pain scores to the morphine group in the first 24 hours and improved pain scores by 48 hours 42 . Comparing continuous SAPB to continuous ESP, patients with SAPB can be expected to have similar pain scores and opioid consumption in the first 24 hours after surgery; however, opioid consumption by 48 hours may be lower in those patients with an ESP catheter 43 …”

Changing paradigms in the practice of cardiac anesthesiology

“…Today, Cardiac anesthesiologists administer multiple fascial plane blocks. In this issue, Toscano A et al [ 4 ] compare continuous erector spinae plane block with serrates anterior plane block for mitral valve surgery by mini-thoracotomy. The current trend indicates that fascial plane blocks will be the standard of care in the next few years.…”