Background and aims:
The ESP block1 has emerged as an alternative to the epidural and used with good success in thoracic surgery2 and patients receiving antiplatelet therapy3. Its superficial interfascial nature and potential safety due to distance from major vascular structures, lung and neuraxis led us to introduce it to our patients undergoing on-pump coronary artery bypass grafting (CABG)4. The aim of this retrospective study was to investigate its utility in our study population.
All patients undergoing CABG receiving bilateral ESP catheters placed at T5 were reviewed. Catheters were injected with 15-20ml of 0.5% Ropivacaine preoperatively with an autobolus of 0.1% Ropivacaine of 10 ml q1hour and a PCA option of 5 ml q30 min postoperatively. Intraoperative analgesia consisted of Ketamine, Fentanyl and Dexmetomidine infusions, with a rebolus option for Ropivacaine at the discretion of the OR team. Additional postoperative analgesia was at the discretion of the primary team.
Three patients were reviewed. Intraoperatively, all received 100 mg of Ketamine in addition of 500 mcg of Fentanyl multimodal analgesia, mean postoperative opioid consumption was 158.33 mcg IV Fentanyl for POD 0-3 in addition to 10-15 mg of Roxicodone PO per day. Median first reported VAS score was 6.5, median scores on POD0 5.5, POD1 1, POD2 and POD3 0. One patient suffered mediastinal hemorrhage due to post-cardiopulmonary bypass coagulopathy requiring transfusion postoperatively, no coagulation and neurologic complications in any of the patients were noted despite perioperative anticoagulation.
The erector spinae block represents analgesic adjunct option and is probably safe for patients undergoing CABG.
1 Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7
2 Luis-Navarro JC, Seda-Guzmán M, Luis-Moreno C, López-Romero JL. The erector spinae plane block in 4 cases of video-assisted thoracic surgery. Rev EspAnestesiol Reanim. 2018 Apr;65(4):204-208.
3 DE Cassai A, Ieppariello G, Ori C. Erector spinae plane block and dual antiplatelet therapy. Minerva Anestesiol. 2018 Apr 10. doi:10.23736/S0375-9393.18.12815-X. [Epub ahead of print]
4 Tsui BCH, Navaratnam M, Boltz G, Maeda K, Caruso TJ. Bilateral automatized intermittent bolus erector spinae plane analgesic blocks for sternotomy in a cardiac patient who underwent cardiopulmonary bypass: A new era of Cardiac Regional Anesthesia. J Clin Anesth. 2018 Apr 19;48:9-10