Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery

P S Nagaraja, S Ragavendran, Naveen G Singh, Omshubham Asai, G Bhavya, N Manjunath, K Rajesh, P S Nagaraja, S Ragavendran, Naveen G Singh, Omshubham Asai, G Bhavya, N Manjunath, K Rajesh

Abstract

Objective: Continuous thoracic epidural analgesia (TEA) is compared with erector spinae plane (ESP) block for the perioperative pain management in patients undergoing cardiac surgery for the quality of analgesia, incentive spirometry, ventilator duration, and intensive care unit (ICU) duration.

Methodology: A prospective, randomized comparative clinical study was conducted. A total of 50 patients were enrolled, who were randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25). Visual analog scale (VAS) was recorded in both the groups during rest and cough at the various time intervals postextubation. Both the groups were also compared for incentive spirometry, ventilator, and ICU duration. Statistical analysis was performed using the independent Student's t-test. A value of P < 0.05 was considered statistically significant.

Results: c: omparable VAS scores were revealed at 0 h, 3 h, 6 h, and 12 h (P > 0.05) at rest and during cough in both the groups. Group A had a statistically significant VAS score than Group B (P ≤ 0.05) at 24 h, 36 h, and 48 h but mean VAS in either of the Group was ≤4 both at rest and during cough. Incentive spirometry, ventilator, and ICU duration were comparable between the groups.

Conclusion: ESP block is easy to perform and can serve as a promising alternative to TEA in optimal perioperative pain management in cardiac surgery.

Keywords: Erector spinae plane block; thoracic epidural analgesia; visual analog scale.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
(a) Sonoanatomy at the level of the T6 spinous process while performing erector spinae plane block. (b) Needle path and hydrodissection while performing erector spinae plane block
Figure 2
Figure 2
Rescue analgesic requirement between Group A (thoracic epidural analgesia) and Group B (erector spinae plane block). X– axis: time interval in hours postextubation. Y– axis: Number of rescue analgesic episodes

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