131 Erector spinae block for perioperative pain management in children undergoing thoracotomy

Background and Aims Thoracotomy for pediatric cardiac surgery can be associated with significant pain. Regional anesthesia techniques such as epidurals and paravertebral blocks can reduce the pain of thoracotomy but can also be associated with significant risk. The erector spinae plane (ESP) block targets the dorsal and ventral rami of spinal nerve roots and has been used extensively for a host of adult surgical procedures. The ESP block is a less invasive option due to the avoidance of the neuraxial and paravertebral spaces. Methods We present a case series in which the ESP block was used successfully in 25 pediatric patients undergoing thoracotomy for cardiac surgery. We compare the ESP to other modalities of perioperative pain management in 29 pediatric patients. Results Patients presented for coarctation repair (5) and vascular ring division (20 patients). The patients ranged in age from 8 months to 17 years of age. The ESP blocks were performed after induction of general anesthesia under ultrasound guidance Intraoperative opioid use was decreased compared to the usual doses used with other blocks or pain management modalities, and post-operative opioid use in the first 24 hours after surgery ranged from 0.05 to 0.5 milligrams per kilogram, significantly lower than other modalities. Postoperative FLACC pain scores were significantly lower in the ESP group in the first 48 hours. Conclusions The erector spinae plane block can potentially lead to decreased intraoperative and post-operative opioid use for pediatric patients undergoing thoracotomy for cardiac surgery.