Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery: A Randomized Controlled Clinical Trial
<i>Background and Objectives</i>: The erector spinae plane block (ESPB) is a multimodal opioid-sparing component, providing chest-wall analgesia of variable extent, duration, and intensity. The objective was to examine the ESPB effect on perioperative opioid usage and postoperative rehab...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-10-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/10/1462 |
| Summary: | <i>Background and Objectives</i>: The erector spinae plane block (ESPB) is a multimodal opioid-sparing component, providing chest-wall analgesia of variable extent, duration, and intensity. The objective was to examine the ESPB effect on perioperative opioid usage and postoperative rehabilitation when used within a Nociception Level (NOL) index-directed anesthetic protocol. <i>Materials and Methods</i>: This prospective, randomized, controlled, open-label study was performed in adult patients undergoing on-pump cardiac surgery in a single tertiary hospital. Eighty-three adult patients who met eligibility criteria were randomly allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 40) and received general anesthesia with NOL index-directed fentanyl dosing. Preoperatively, group 2 also received bilateral single-shot ultrasound-guided ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Postoperatively, both groups received intravenous paracetamol (1 g every 6 h). Morphine (0.03 mg/kg) was administered for numeric rating scale (NRS) scores ≥4. <i>Results</i>: The median (IQR, 25th–75th percentiles) intraoperative fentanyl and 48 h morphine dose in group 2-to-group 1 were 1.2 (1.1–1.5) vs. 4.5 (3.8–5.5) µg·kg<sup>−1</sup>·h<sup>−1</sup> (<i>p</i> < 0.001) and 22.1 (0–40.4) vs. 60.6 (40–95.7) µg/kg (<i>p</i> < 0.001). The median (IQR) time to extubation in group 2-to-group 1 was 90 (60–105) vs. 360 (285–510) min (<i>p</i> < 0.001). Two hours after ICU admission, 87.5% of ESPB patients were extubated compared to 0% of controls (<i>p</i> < 0.001), and 87.5% were weaned off norepinephrine compared to 46.5% of controls (<i>p</i> < 0.001). The median NRS scores at 0, 6, 12, 24, and 48 h after extubation were significantly decreased in group 2. There was no difference in opioid-related adverse events and length of stay. <i>Conclusions</i>: NOL index-directed ESPB reduced intraoperative fentanyl by 73.3% and 48 h morphine by 63.5%. It also hastened the extubation and liberation from vasopressor support and improved postoperative analgesia. |
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| ISSN: | 1010-660X 1648-9144 |