Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial
| Autor: | Kim Dinh Nguyen Thien, Nga Ho, Vien Nguyen, Philippe Macaire, Hieu Phan Van, Sophie Bringuier, Xavier Capdevila |
|---|---|
| Přispěvatelé: | Vinmec International Hospital [Hanoï], Vinmec Central Park International Hospital [Ho Chi Minh City], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Placebo-controlled study MESH: Ultrasonography Interventional MESH: Analgesics Opioid nerve block 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology MESH: Child medicine postoperative pain MESH: Pain Postoperative MESH: Cardiac Surgical Procedures MESH: Humans Ropivacaine business.industry General Medicine MESH: Nerve Block 3. Good health Cardiac surgery Anesthesiology and Pain Medicine MESH: Analgesia Opioid Anesthesia FLACC scale Vomiting Nerve block Morphine analgesics opioid medicine.symptom business regional anesthesia 030217 neurology & neurosurgery [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology medicine.drug |
| Zdroj: | Regional Anesthesia and Pain Medicine Regional Anesthesia and Pain Medicine, Lippincott, Williams & Wilkins, 2020, 45 (10), pp.805-812. ⟨10.1136/rapm-2020-101496⟩ |
| ISSN: | 1098-7339 |
| Popis: | BackgroundPostoperative pain after pediatric cardiac surgery is usually treated with intravenous opioids. Recently, the focus has been on postoperative regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks (ESPBs). We hypothesized that bilateral ESPB with a programmed intermittent bolus (PIB) regimen decreases postoperative morphine consumption at 48 hours and improves analgesia in children who undergo cardiac surgery.MethodsThis randomized, double-blind, placebo-controlled study comprised 50 children who underwent cardiac surgery through midline sternotomy. The patients were allocated randomly into two groups: ultrasound-guided bilateral ESPB at the level of T3–T4 transverse process then PIB with saline infusion (group 1, n=23) or PIB with 0.2% ropivacaine (group 2, n=27). Intravenous morphine at 30 µg/kg/hour was used as rescue analgesia. Postoperative pain was assessed using the COMFORT-B score for extubation, drain removal, and mobilization, and the FLACC (Face, Legs, Activity, Cry, Consolability) scale at 0, 2, 4, 6, 8, 12, 16, 20, 24, 36, and 48 hours after surgery. Adverse events were noted.ResultsThe total dose of morphine in 48 hours was significantly decreased in patients receiving a bilateral ESPB with ropivacaine (120±320 µg/kg) compared with patients with saline infusion (512±560 µg/kg; p=0.03). Fourteen per cent of patients required rescue analgesia with morphine in group 2 compared with 41% in group 1 (p=0.05). The patients in group 2 demonstrated significantly reduced COMFORT-B scores at extubation, drain removal, and mobilization compared with those in group 1 and had reduced FLACC scale levels at 20 and 24 hours postoperatively (p=0.05 and p=0.001, respectively). No differences were reported for extubation and drain removal times or for length of hospital stay. In addition, vomiting episodes were decreased in group 2 (p=0.01).ConclusionsIn pediatric cardiac surgery, the results of this study confirm our hypothesis that bilateral ESPB analgesia with ropivacaine decreases the postoperative morphine consumption at 48 hours and demonstrates better postoperative analgesia compared with a control group.Trial registration numberNCT03593642. |
| Databáze: | OpenAIRE |
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