J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 15, Number 1, January 2024, pages 26-30

Continuous Erector Spinae Plane Block for Pain Management Following Thoracotomy for Aortic Coarctectomy

**Table 1.** Reports of ESPB Following Thoracotomy or Sternotomy in the Pediatric Population
Authors and reference	Study type and demographics	Treatment and outcomes
CHD: congenital heart disease; CPB: cardiopulmonary bypass; ESPB: erector spinae plane block; MOPS: modified objective pain score; VAS: visual analogue scale; TEA: thoracic epidural anesthesia; FLACC: Face, Legs, Activity, Cry, Consolability.
Kaushal et al, 2020 [5]	Prospective, randomized study. Study cohort of 80 children with acyanotic CHD for surgery with sternotomy and CPB.	Bilateral ESPB versus no block (control). Patients who received an ESPB had reduced MOPS, required significantly less, and had a prolonged time to postoperative fentanyl needs, and a lower postoperative sedation score. Ultrasound-guided bilateral ESPB was a reliable and effective postoperative analgesic modality for pediatric cardiac surgery through a midline sternotomy.
Macaire et al, 2020 [8]	Randomized, double-blind, placebo-controlled trial. Study cohort included 50 children following cardiac surgery with midline sternotomy.	Bilateral ESPB with 0.2% ropivacaine infusion versus saline infusion. Morphine requirements and intraoperative sufentanil were reduced in the ESPB group. Time to chest tube removal, first mobilization, pain scores (VAS) 2 h after chest tube removal, pain scores (VAS) at rest 1 month after surgery, and postoperative adverse events were decreased in the ESPB group. ESPB resulted in a decrease in intraoperative and postoperative opioid consumption, optimized rapid patient mobilization, and chest tube removal after cardiac surgery.
Singh et al, 2022 [10]	Prospective randomized controlled trial. Study cohort included 40 children, 2 - 7 years of age, scheduled for right or left thoracotomy under general anesthesia.	TEA versus ESPB analgesia. Intraoperative fentanyl requirements were greater in the TEA group when compared to the ESPB group while postoperative fentanyl requirements were comparable. The median FLACC score was equivalent between both groups. Higher incidence of adverse effects with TEA. ESPB provided similar postoperative analgesia to TEA with a lower incidence of adverse effects in pediatric patients undergoing thoracotomy.

Table 1. Reports of ESPB Following Thoracotomy or Sternotomy in the Pediatric Population

Authors and reference

Study type and demographics

Treatment and outcomes

CHD: congenital heart disease; CPB: cardiopulmonary bypass; ESPB: erector spinae plane block; MOPS: modified objective pain score; VAS: visual analogue scale; TEA: thoracic epidural anesthesia; FLACC: Face, Legs, Activity, Cry, Consolability.

Kaushal et al, 2020 [5]

Prospective, randomized study. Study cohort of 80 children with acyanotic CHD for surgery with sternotomy and CPB.

Bilateral ESPB versus no block (control). Patients who received an ESPB had reduced MOPS, required significantly less, and had a prolonged time to postoperative fentanyl needs, and a lower postoperative sedation score. Ultrasound-guided bilateral ESPB was a reliable and effective postoperative analgesic modality for pediatric cardiac surgery through a midline sternotomy.

Macaire et al, 2020 [8]

Randomized, double-blind, placebo-controlled trial. Study cohort included 50 children following cardiac surgery with midline sternotomy.

Bilateral ESPB with 0.2% ropivacaine infusion versus saline infusion. Morphine requirements and intraoperative sufentanil were reduced in the ESPB group. Time to chest tube removal, first mobilization, pain scores (VAS) 2 h after chest tube removal, pain scores (VAS) at rest 1 month after surgery, and postoperative adverse events were decreased in the ESPB group. ESPB resulted in a decrease in intraoperative and postoperative opioid consumption, optimized rapid patient mobilization, and chest tube removal after cardiac surgery.

Singh et al, 2022 [10]

Prospective randomized controlled trial. Study cohort included 40 children, 2 - 7 years of age, scheduled for right or left thoracotomy under general anesthesia.

TEA versus ESPB analgesia. Intraoperative fentanyl requirements were greater in the TEA group when compared to the ESPB group while postoperative fentanyl requirements were comparable. The median FLACC score was equivalent between both groups. Higher incidence of adverse effects with TEA. ESPB provided similar postoperative analgesia to TEA with a lower incidence of adverse effects in pediatric patients undergoing thoracotomy.

**Table 2.** Reports of ESPB Following Thoracotomy or Sternotomy in the Adult Population
Authors and reference	Study type and demographics	Treatment and outcomes
ESPB: erector spinae plane block; CPIS: clinical pulmonary infection score; MME: morphine milligram equivalents; TPVB: thoracic paravertebral block; VAS: visual analogue scale; PCA: patient-controlled analgesia; PONS: postoperative nausea and vomiting; NRS: numeric rate scale; RATS: robotic-assisted thoracic surgery.
Sun et al, 2021 [4]	Propensity score matched, retrospective cohort study. Study cohort included 452 consecutive adults for cardiac surgery through a lateral mini-thoracotomy.	Intermittent bolus ESPB via a catheter for 3 days versus no regional anesthesia. ESPB group had a lower oral MME, received fewer doses of antiemetic agents, and had a lower modified CPIS. Intermittent bolus ESPB is safe and resulted in a reduction of opioid use and decreased need for antiemetic agents following cardiac surgery through a lateral mini-thoracotomy.
Fang et al, 2019 [14]	Randomized, controlled, double-blind study. Study cohort included 94 adult patients who underwent thoracotomy for lung surgery.	Preoperative single-injection ESPB versus preoperative single-injection TPVB. Patients in both groups were also provided with a sufentanil PCA. There were no significant differences in VAS, sufentanil use, or PONV following surgery. There was significantly less hypotension, bradycardia, hematoma formation, and a higher single attempt success rate with ESPB. Preoperative single-injection ESPB plus postoperative sufentanil PCA provided similar pain relief for patients undergoing thoracotomy when compared to TPVB.
Cavaleri et al, 2021 [15]	Retrospective case series, eight adults who underwent an elective RATS procedure.	ESPB was performed after surgery with an initial bolus of local anesthetic agent followed by catheter insertion for continuous infusion. Based on NRS score, ESPB reduced postoperative opioid needs.

Table 2. Reports of ESPB Following Thoracotomy or Sternotomy in the Adult Population

Authors and reference

Study type and demographics

Treatment and outcomes

ESPB: erector spinae plane block; CPIS: clinical pulmonary infection score; MME: morphine milligram equivalents; TPVB: thoracic paravertebral block; VAS: visual analogue scale; PCA: patient-controlled analgesia; PONS: postoperative nausea and vomiting; NRS: numeric rate scale; RATS: robotic-assisted thoracic surgery.

Sun et al, 2021 [4]

Propensity score matched, retrospective cohort study. Study cohort included 452 consecutive adults for cardiac surgery through a lateral mini-thoracotomy.

Intermittent bolus ESPB via a catheter for 3 days versus no regional anesthesia. ESPB group had a lower oral MME, received fewer doses of antiemetic agents, and had a lower modified CPIS. Intermittent bolus ESPB is safe and resulted in a reduction of opioid use and decreased need for antiemetic agents following cardiac surgery through a lateral mini-thoracotomy.

Fang et al, 2019 [14]

Randomized, controlled, double-blind study. Study cohort included 94 adult patients who underwent thoracotomy for lung surgery.

Preoperative single-injection ESPB versus preoperative single-injection TPVB. Patients in both groups were also provided with a sufentanil PCA. There were no significant differences in VAS, sufentanil use, or PONV following surgery. There was significantly less hypotension, bradycardia, hematoma formation, and a higher single attempt success rate with ESPB. Preoperative single-injection ESPB plus postoperative sufentanil PCA provided similar pain relief for patients undergoing thoracotomy when compared to TPVB.

Cavaleri et al, 2021 [15]

Retrospective case series, eight adults who underwent an elective RATS procedure.

ESPB was performed after surgery with an initial bolus of local anesthetic agent followed by catheter insertion for continuous infusion. Based on NRS score, ESPB reduced postoperative opioid needs.