Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial
<i>Background and Objectives:</i> The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperati...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/2/265 |
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| author | Cosmin Balan Dana R. Tomescu Serban I. Bubenek-Turconi |
| author_facet | Cosmin Balan Dana R. Tomescu Serban I. Bubenek-Turconi |
| author_sort | Cosmin Balan |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index. <i>Materials and Methods:</i> This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control, <i>n</i> = 43) and group 2 (ESPB, <i>n</i> = 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli. <i>Results:</i> The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (<i>p</i> < 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (<i>p</i> < 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (<i>p</i> < 0.001). <i>Conclusions:</i> The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation. |
| first_indexed | 2024-03-11T08:27:52Z |
| format | Article |
| id | doaj.art-e3222527c26140ce839657978ff85754 |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T08:27:52Z |
| publishDate | 2023-01-01 |
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| spelling | doaj.art-e3222527c26140ce839657978ff857542023-11-16T21:59:23ZengMDPI AGMedicina1010-660X1648-91442023-01-0159226510.3390/medicina59020265Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical TrialCosmin Balan0Dana R. Tomescu1Serban I. Bubenek-Turconi2Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, RomaniaAnesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, RomaniaCardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania<i>Background and Objectives:</i> The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index. <i>Materials and Methods:</i> This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control, <i>n</i> = 43) and group 2 (ESPB, <i>n</i> = 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli. <i>Results:</i> The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (<i>p</i> < 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (<i>p</i> < 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (<i>p</i> < 0.001). <i>Conclusions:</i> The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation.https://www.mdpi.com/1648-9144/59/2/265erector spinae plane blockopen heart surgerynociception monitoringnociception level indexanalgesia |
| spellingShingle | Cosmin Balan Dana R. Tomescu Serban I. Bubenek-Turconi Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial Medicina erector spinae plane block open heart surgery nociception monitoring nociception level index analgesia |
| title | Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial |
| title_full | Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial |
| title_fullStr | Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial |
| title_full_unstemmed | Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial |
| title_short | Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial |
| title_sort | nociception control of bilateral single shot erector spinae plane block compared to no block in open heart surgery a post hoc analysis of the nesp randomized controlled clinical trial |
| topic | erector spinae plane block open heart surgery nociception monitoring nociception level index analgesia |
| url | https://www.mdpi.com/1648-9144/59/2/265 |
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