Siva N Krishna1, Sandeep Chauhan2, Debesh Bhoi3, Brajesh Kaushal2, Suruchi Hasija2, Tsering Sangdup4, Akshay K Bisoi4. 1. Department of Cardiac Anesthesiology, Cardio and Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India. Electronic address: krissiva@live.in. 2. Department of Cardiac Anesthesiology, Cardio and Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Cardiothoracic and Vascular Surgery, Cardio and Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
Abstract
OBJECTIVES: To examine the analgesic efficacy of bilateral erector spinae plane (ESP) block compared with conventional treatment for pain after cardiac surgery in adult patients. DESIGN: A prospective, randomized, controlled, single-blinded study. SETTING: Single-center tertiary teaching hospital. PARTICIPANTS: One hundred and six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Patients were randomized into 2 groups. Patients in group 1 (ESP block group, n = 53) received ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine before anesthesia induction at the T6 transverse process level. Patients in group 2 (paracetamol and tramadol group, n = 53) received paracetamol (1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in the postoperative period. The primary study outcome was to evaluate pain at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test was used for comparing NRS scores. MEASUREMENTS AND MAIN RESULTS: The postoperative pain level after extubation and duration of analgesia during which NRS was < 4 of 10 was compared between the groups. The median pain score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were significantly less in comparison with group 2 (p = 0.0001). Patients in group 1 had a significantly higher mean duration of analgesia (8.98 ± 0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60 ± 0.12 hours) (p = 0.0001). CONCLUSION: ESP block safely provided significantly better pain relief at rest for longer duration as compared to intravenous paracetamol and tramadol.
OBJECTIVES: To examine the analgesic efficacy of bilateral erector spinae plane (ESP) block compared with conventional treatment for pain after cardiac surgery in adult patients. DESIGN: A prospective, randomized, controlled, single-blinded study. SETTING: Single-center tertiary teaching hospital. PARTICIPANTS: One hundred and six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Patients were randomized into 2 groups. Patients in group 1 (ESP block group, n = 53) received ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine before anesthesia induction at the T6 transverse process level. Patients in group 2 (paracetamol and tramadol group, n = 53) received paracetamol (1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in the postoperative period. The primary study outcome was to evaluate pain at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test was used for comparing NRS scores. MEASUREMENTS AND MAIN RESULTS: The postoperative pain level after extubation and duration of analgesia during which NRS was < 4 of 10 was compared between the groups. The median pain score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of 10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were significantly less in comparison with group 2 (p = 0.0001). Patients in group 1 had a significantly higher mean duration of analgesia (8.98 ± 0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60 ± 0.12 hours) (p = 0.0001). CONCLUSION: ESP block safely provided significantly better pain relief at rest for longer duration as compared to intravenous paracetamol and tramadol.