Using the blockade of interfascial space of the erector spinae muscle (erector spinae plane block) in minimally invasive coronary bypass surgery: prospective randomized study

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.

Keywords

combined anesthesia / regional anesthesia / ESP block / minimally invasive coronary bypass surgery / MIDCAB / multimodal anesthesia

References

[1] Ageenko AM, Sadovoy MA, Shelyakina OV, Ovtin MA. Fast-track hip and knee arthroplasty (literature review). Traumatology and Orthopedics of Russia. 2017;23(4):146–155. (In Russ). doi: 10.21823/2311-2905-2017-23-4-146-155

[2] Агеенко А.М., Садовой М.А., Шелякина О.В., Овтин М.А. Технология ускоренной реабилитации после эндопротезирования тазобедренного и коленного суставов (обзор литературы) // Травматология и ортопедия России. 2017.Т. 23, № 4.С. 146–155. doi: 10.21823/2311-2905-2017-23-4-146-155

[3] Zante B, Erdoes G. Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable? J Cardiothorac Vasc Anesth. 2019;33(10):2717–2718. doi: 10.1053/j.jvca.2019.04.008

[4] Zante B., Erdoes G. Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable? // J Cardiothorac Vasc Anesth. 2019. Vol. 33, N 10. P. 2717–2718. doi: 10.1053/j.jvca.2019.04.008

[5] Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015;19(4):451–465. doi: 10.1002/ejp.567

[6] Humble S.R., Dalton A.J., Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy//Eur J Pain. 2015. Vol. 19, N 4. P. 451–465. doi: 10.1002/ejp.567

[7] Baxter R, Squiers J, Conner W, et al. Enhanced Recovery After Surgery: A Narrative Review of its Application in Cardiac Surgery. Ann Thorac Surg. 2020;109(6):1937–1944. doi: 10.1016/j.athoracsur.2019.11.008

[8] Baxter R., Squiers J., Conner W., et al. Enhanced Recovery After Surgery: ANarrative Review of its Application in Cardiac Surgery// Ann Thorac Surg. 2020. Vol. 109, N 6. P. 1937–1944. doi: 10.1016/j.athoracsur.2019.11.008

[9] Sidiropoulou T, Pompeo E, Bozzao A, et al. Epidural hematoma after thoracic epidural catheter removal in the absence of risk factors. Reg Anesth Pain Med. 2003;28(6):531–534. doi: 10.1016/s1098-7339(03)00388-2

[10] Sidiropoulou T., Pompeo E., Bozzao A., et al. Epidural hematoma after thoracic epidural catheter removal in the absence of risk factors // Reg Anesth Pain Med. 2003. Vol. 28, N 6. P. 531–534. doi: 10.1016/s1098-7339(03)00388-2

[11] Niesen AD, Jacob AK, Law LA, et al. Complication rate of ultrasound-guided paravertebral block for breast surgery. Reg Anesth Pain Med. 2020;45(10):813–817. doi: 10.1136/rapm-2020-101402

[12] Niesen A.D., Jacob A.K., Law L.A., et al. Complication rate of ultrasound-guided paravertebral block for breast surgery // Reg Anesth Pain Med. 2020. Vol. 45, N 10. P. 813–817. doi: 10.1136/rapm-2020-101402

[13] Dualé C, Gayraud G, Taheri H, et al. A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery. J Cardiothorac Vasc Anesth. 2015;29(4):942–949. doi: 10.1053/j.jvca.2014.11.006

[14] Dualé C., Gayraud G., Taheri H., et al. A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery // J Cardiothorac Vasc Anesth. 2015. Vol. 29, N 4. P. 942–949. doi: 10.1053/j.jvca.2014.11.006

[15] Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41(5):621–627. doi: 10.1097/AAP.0000000000000451

[16] Forero M., Adhikary S.D., Lopez H., et al. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain //Reg Anesth Pain Med. 2016. Vol. 41, N 5. P. 621–627. doi: 10.1097/AAP.0000000000000451

[17] Hoogma DF, Rex S, Tournoy J, et al. Erector spinae plane block for minimally invasive mitral valve surgery: a double-blind, prospective, randomized placebo-controlled trial-a study protocol. BMJ Open. 2021;11(4):e045833. doi: 10.1136/bmjopen-2020-045833

[18] Hoogma D.F., Rex S., Tournoy J., et al. Erector spinae plane block for minimally invasive mitral valve surgery: a double-blind, prospective, randomized placebo-controlled trial-a study protocol // BMJ Open. 2021. Vol. 11, N 4. P. e045833. doi: 10.1136/bmjopen-2020-045833

[19] Glushhenko VA, Irklienko EK. Cardiovascular morbidity — one of the most vital problems of modern health care. Meditsina i organizatsiya zdravookhraneniya.2019;4(1):56–63. (In Russ).

[20] Глущенко В.А., Ирклиенко Е.К. Сердечно-сосудистая заболеваемость — одна из важнейших проблем здравоохранения // Медицина и организация здравоохранения. 2019. Т. 4, № 1. С. 56–63.

[21] Volchkov VA, Boyarkin AA, Balandina EV, et al. Influence of inhalation and epidural anesthesia on complications after coronary artery bypass grafting. Russian Journal of Thoracic and Cardiovascular Surgery. 2019;61(6):525–531. (In Russ). doi: 10.24022/0236-2791-2019-61-6-525-531

[22] Волчков В.А., Бояркин А.А., Баландина Е.В., и др. Влияние ингаляционной и эпидуральной анестезии на развитие осложнений после аортокоронарного шунтирования // Грудная и сердечно-сосудистая хирургия. 2019. Т. 61, № 6. С. 525–531. doi: 10.24022/0236-2791-2019-61-6-525-531

[23] Koriachkin VA, Zabolotsky DV. Place of regional blocks in surgical anesthesia. Medicine: Theory and Practice. 2018;3(4):65–69. (In Russ).

[24] Корячкин В.А., Заболотский Д.В. Место регионарных методов анестезии в хирургическом обезболивании //Медицина: теория и практика. 2018. Т. 3, № 4. С. 65–69.

[25] Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, et al. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019;4:9–33. (In Russ). doi: 10.21320/1818-474X-2019-4-9-33

[26] Овечкин А.М., Баялиева А.Ж., Ежевская А.А. и др. Послеоперационное обезболивание. Клинические рекомендации // Вестник интенсивной терапии им. А.И. Салтанова. 2019. № 4. С. 9–33. doi: 10.21320/1818-474X-2019-4-9-33

[27] Koriachkin VA, Spasova AP, Khinovker VV. Neuropathic pain. Innovative Medicine of Kuban. 2021;2:58–64.(In Russ). doi: 10.35401/2500-0268-2021-22-2-58-64

[28] Корячкин В.А., Спасова А.П., Хиновкер В.В. Нейропатическая боль // Инновационная медицина Кубани. 2021. Т. 22, № 2.С. 58–64. doi: 10.35401/2500-0268-2021-22-2-58-64

[29] Arends S, Böhmer AB, Poels M, et al. Post-thoracotomy pain syndrome: seldom severe, often neuropathic, treated unspecific, and insufficient. Pain Rep. 2020;5(2):e810. doi: 10.1097/PR9.0000000000000810

[30] Arends S., Böhmer A.B., Poels M., et al. Post-thoracotomy pain syndrome: seldom severe, often neuropathic, treated unspecific, and insufficient // Pain Rep. 2020. Vol. 5, N 2. P. e810. doi: 10.1097/PR9.0000000000000810

[31] Rubinchik VE, Kasherininov IY, Bautin AE, Mazurok VA. Treatment of delirium in early postoperative cardiosurgical patients. Annals of Critical Care. 2019;(3):77–83. (In Russ). doi: 10.21320/1818-474X-2019-3-77-83

[32] Рубинчик В.Е., Кашерининов И.Ю., Баутин А.Е., Мазурок В.А. Терапия делириозного синдрома у пациентов кардиохирургического профиля в раннем послеоперационном периоде // Вестник интенсивной терапии им. А.И. Салтанова. 2019. № 3.С. 77–83. doi: 10.21320/1818-474X-2019-3-77-83

[33] Bignami E, Castella A, Pota V, et al. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol. 2018;84(4):488–503. doi: 10.23736/S0375-9393.17.12142-5

[34] Bignami E., Castella A., Pota V., et al. Perioperative pain management in cardiac surgery: a systematic review //Minerva Anestesiol. 2018. Vol. 84, N 4. P. 488–503. doi: 10.23736/S0375-9393.17.12142-5

[35] Zorrilla-Vaca A, Rice D, Brown JK, et al. Sustained reduction of discharge opioid prescriptions in an enhanced recovery after thoracic surgery program: A multilevel generalized linear model. Surgery. 2022;171(2):504–510. doi:0.1016/j.surg.2021.08.039

[36] Zorrilla-Vaca A., Rice D., Brown J.K., et al. Sustained reduction of discharge opioid prescriptions in an enhanced recovery after thoracic surgery program: A multilevel generalized linear model // Surgery. 2022. Vol. 171, N 2. P. 504–510. doi:0.1016/j.surg.2021.08.039

[37] Leonov AA, Koryachkin VA, Zabolotskii DV, et al. Primenenie metodov regionarnoi anestezii v obshchekhirurgicheskoi praktike kak komponenta fast-track. 3rd All-Russian Congress with International Participation «Aktual’nye voprosy meditsiny kriticheskikh sostoyanii»; 2021 May 11–13; St. Petersburg. Moscow: OOO «Moskovskoe Kongressnoe Byuro»; 2021. P. 45–46. Available from: https://www.niioncologii.ru/news/iii_vserossiyskiy_kongress _s_mezhdunarodnym_uchastiem_aktualnye_voprosy_meditsiny_kriticheskikh_sost. Accessed: 06.02.2023. (In Russ).

[38] Леонов А.А., Корячкин В.А., Заболоцкий Д.В., и др. Применение методов регионарной анестезии в общехирургической практике как компонента fast-track // III Всероссийский конгресс с международным участием «Актуальные вопросы медицины критических состояний»; Май 11–13, 2021; Санкт-Петербург. Москва: ООО «Московское Конгрессное Бюро», 2021. С. 45–46. Режим доступа: https://www.niioncologii.ru/news/iii_vserossiyskiy_kongress_s_mezhdunarodnym_uchastiem_aktualnye_voprosy_meditsiny_kriticheskikh_sost. Дата обращения: 06.02.2023.

[39] Svircevic V, Passier MM, Nierich AP, et al. Epidural analgesia for cardiac surgery. Cochrane Database Syst Rev. 2013;(6):CD006715. doi: 10.1002/14651858.CD006715.pub2. Update in: Cochrane Database Syst Rev. 2019;3:CD006715.

[40] Svircevic V., Passier M.M., Nierich A.P., et al. Epidural analgesia for cardiac surgery // Cochrane Database Syst Rev. 2013. N 6. CD006715. doi: 10.1002/14651858.CD006715.pub2. Update in: Cochrane Database Syst Rev. 2019. N 3. CD006715.

[41] Scarfe AJ, Schuhmann-Hingel S, Duncan JK, et al. Continuous paravertebral block for post-cardiothoracic surgery analgesia: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50(6):1010–1018. doi: 10.1093/ejcts/ezw168

[42] Scarfe A.J., Schuhmann-Hingel S., Duncan J.K., et al. Continuous paravertebral block for post-cardiothoracic surgery analgesia: a systematic review and meta-analysis // Eur J Cardiothorac Surg. 2016. Vol. 50, N 6. P. 1010–1018. doi: 10.1093/ejcts/ezw168

[43] Landoni G, Isella F, Greco M, et al. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015;115(1):25–32. doi: 10.1093/bja/aev201

[44] Landoni G., Isella F., Greco M., et al. Benefits and risks of epidural analgesia in cardiac surgery // Br J Anaesth. 2015. Vol. 115, N 1. P. 25–32. doi: 10.1093/bja/aev201

[45] Kelly ME, Mc Nicholas D, Killen J, et al. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J. 2018;24(1):23–27. doi: 10.1111/tbj.12831

[46] Kelly M.E., Mc Nicholas D., Killen J., et al. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases // Breast J. 2018. Vol. 24, N 1. P. 23–27. doi: 10.1111/tbj.12831

[47] Koryachkin VA. Peripheral nerve blocks and ultrasound navigation. Regional Anesthesia and Acute Pain Management. 2020;14(1):4–5.(In Russ). doi: 10.17816/1993-6508-2020-14-1-4-5

[48] Корячкин В.А. Блокады периферических нервов и ультразвуковая навигация // Регионарная анестезия и лечение острой боли. 2020.Т. 14, № 1. С. 4–5. doi: 10.17816/1993-6508-2020-14-1-4-5

[49] De Cassai A, Geraldini F, Carere A, et al. Complications Rate Estimation After Thoracic Erector Spinae Plane Block. J Cardiothorac Vasc Anesth. 2021;35(10):3142–3143. doi: 10.1053/j.jvca.2021.02.043

[50] De Cassai A., Geraldini F., Carere A., et al. Complications Rate Estimation After Thoracic Erector Spinae Plane Block // J Cardiothorac Vasc Anesth. 2021. Vol. 35, N 10. P. 3142–3143. doi: 10.1053/j.jvca.2021.02.043

[51] Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial. J Clin Anesth. 2020;59:84–88. doi: 10.1016/j.jclinane.2019.06.036

[52] Gürkan Y., Aksu C., Kuş A., Yörükoğlu U.H. Erector spinae plane block and thoracic paravertebral block for breast surgery compared to IV-morphine: A randomized controlled trial // J Clin Anesth. 2020. N 59. P. 84–88. doi: 10.1016/j.jclinane.2019.06.036

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