Bilateral spinae erector plane blockade as postoperative multimodal analgesia in cardiac surgery: an observational case series

Introduction The post-op acute pain in the thoracic region, characterizes for a component of a superficial deep somatic pain, which presents its most intensity within 24 hours and decreases progressively within the next few days. It has been seen that the highest pain intensity persists during the first 48 hours and decreases from the third day. Nonetheless, the inadequate analgesia in the post-op, could lead to a to a perioperative surgical response to uninhibited stress, which can relate in a direct form with the beginning of pathophysiological changes in all systems. The analgesic mechanism of the ESP block, it's due to the interruption of the sensitive input of the ventral and dorsal branch of the spinal nerve roots, the spinal-caudal spread extends 3 or 4 levels above and below the point of administration of the local anesthetic. Objetives To describe the impact of bilateral spinal erector plane block in cardiac surgery by assessing pain intensity using the Analog Pain Scale (VAS) 24 hours and 48 hours postoperatively at rest and in valsalva, and the Measurement of opioid consumption with the use of a hydromorphone PCA pump. Methods Admitted 19 patients to cardiac surgery of low risk receive bilateral ESP block at a T6 level, with local anesthesia with a total volume of 20cc, (10 cc 1% lidocaine and 10cc 0,5% bupivacaine). All patients received propofol 1mg / kg, fentanyl 2mcg / kg, rocuronium 0.6mg / kg or cisatracurium if CKD (0.1-0.2mg / kg) and initial bolus dexmedetomidine 0.5mcg / kg for induction. Maintenance with dexmedetomidine 0.4 mcg / kg / hr, sevoflurane guided by anesthetic depth monitoring, Dexamethasone 8 mg, paracetamol 1 gr every 6 hours and hydromorphone 0.4 mg. In de ICU, the pain management was paracetamol 1 gr every 6 horas, and opioid PCA is installed for objective assessment of the intake and VAS is evaluated immediately, 24 and 48 hours of postsurgical at rest and valsalva. Results Results: We signed up 19 patients, average age 54 years, with average VAS at rest and Valsalva respectively, immediate EVA 1.2 and 2,8, at 24 hours 1.4 and 4.4 at 48 hours 2,1 and 4.6, with an average consume of opioids 0.9 mg of hydromorphone at 24 hours and 1.3 mg at 48 hours Discussion Conclusions: The erector spine block is a tool to consider for the multidisciplinary management of postoperative pain in cardiac surgery, which offers adequate modulation of deep and superficial somatic pain during the first 48 hours, and a decrease in intravenous opioid consumption, and consequently the reduction of the secondary effects originated from the use of said drugs.