Erector Spinae blocks are opioid-sparing in pediatric patients after congenital cardiac surgery.
Presented During:
Monday, May 8, 2023: 8:15AM - 8:30AM
Los Angeles Convention Center
Posted Room Name:
403B
Abstract No:
205
Submission Type:
Abstract Submission
Authors:
Nathalie Roy (1), Nathalie Roy (1), Morgan Brown (1), Sarah Blitz (2), M. Fernanda Parra (1), Lynn Sleeper (1), Joseph Kossowsky (3), Viviane Nasr (1), Pedro J. del Nido (1), Roland Brusseau (1)
Institutions:
(1) Boston Children's Hospital, Boston, MA, (2) Harvard Medical School, Boston, MA, (3) Boston Childrens Hospital, Boston, MA
Submitting Author:
*Nathalie Roy
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Boston Children's Hospital
Boston Children's Hospital
Co-Author(s):
*Nathalie Roy
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Boston Children's Hospital
Boston Children's Hospital
Morgan Brown
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Boston Children's Hospital
Boston Children's Hospital
Sarah Blitz
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Harvard Medical School
Harvard Medical School
M. Fernanda Parra
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Boston Children's Hospital
Boston Children's Hospital
Lynn Sleeper
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Boston Children's Hospital
Boston Children's Hospital
Joseph Kossowsky
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Boston Childrens Hospital
Boston Childrens Hospital
Viviane Nasr
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Boston Children's Hospital
Boston Children's Hospital
*Pedro del Nido
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Boston Children's Hospital
Boston Children's Hospital
Roland Brusseau
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Boston Children's Hospital
Boston Children's Hospital
Presenting Author:
*Nathalie Roy
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Boston Children's Hospital
Boston Children's Hospital
Abstract:
Objective: Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate: the efficacy of bilateral continuous erector spinae blocks (B-ESpB) for postoperative analgesia in children undergoing cardiac surgery in an Enhanced Recovery After Surgery (ERAS) program; the opioid-sparing effect of the B-ESpB; and the impact on recovery.
Methods: Patients ages 2 to <18 yrs undergoing cardiac surgery in the ERAS program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions for 48 hrs. Participants wore a smartwatch in the ICU until discharge. B-ESpB patients were retrospectively matched 1:2 with control patients in the ERAS program according to procedure and diagnosis. Other characteristics for matching included: Age, BMI, CPB, gender, prior sternotomies, and associated conditions. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling. To meet model assumptions, variables were log- or square-root-transformed when necessary.
Results: Group sizes were 40 B-ESpB and 78 ERAS controls. There were no major complications from the B-ESpBs, and additional operating room time was 31 min. There was no difference in early extubation between groups (table). B-ESpB received fewer opioids in oral morphine equivalent (OME) than ERAS controls at 24 hours (0.60±0.06 vs 0.78±0.04, OME; mg/kg, p= 0.02) and at 48 hours (1.13±0.08 vs 1.35±0.06, OME; mg/kg, p= 0.04), respectively. Fewer non-opioid analgesics were administered in B-ESpB than ERAS controls: 2.5±1.1 vs. 2.9±1.0 mg/kg IV ketorolac, p= 0.049. Both groups had similar low median pain scores per shift. There was no difference in early mobilization, length of stay, and complications. At 6-day follow-up (IQR 5-9), similar percentages of patients reported use of pain medication, and no opioids in the B-ESpB group. In the B-ESpB patients with smartwatch, there was no correlation of OME or pain score with measures of heart rate variability or steps taken prior to discharge. There was a mild correlation (R=0.28) between OME and ratio of REM vs. total sleep (p=0.10).
Conclusion: B-ESpB are safe in children undergoing cardiac surgery. When B-ESpB is performed as part of a multimodal pain strategy in an ERAS program, pediatric patients experience good pain control and require fewer opioids in the first 48 hours however, there was no impact on length of stay.
Methods: Patients ages 2 to <18 yrs undergoing cardiac surgery in the ERAS program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions for 48 hrs. Participants wore a smartwatch in the ICU until discharge. B-ESpB patients were retrospectively matched 1:2 with control patients in the ERAS program according to procedure and diagnosis. Other characteristics for matching included: Age, BMI, CPB, gender, prior sternotomies, and associated conditions. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling. To meet model assumptions, variables were log- or square-root-transformed when necessary.
Results: Group sizes were 40 B-ESpB and 78 ERAS controls. There were no major complications from the B-ESpBs, and additional operating room time was 31 min. There was no difference in early extubation between groups (table). B-ESpB received fewer opioids in oral morphine equivalent (OME) than ERAS controls at 24 hours (0.60±0.06 vs 0.78±0.04, OME; mg/kg, p= 0.02) and at 48 hours (1.13±0.08 vs 1.35±0.06, OME; mg/kg, p= 0.04), respectively. Fewer non-opioid analgesics were administered in B-ESpB than ERAS controls: 2.5±1.1 vs. 2.9±1.0 mg/kg IV ketorolac, p= 0.049. Both groups had similar low median pain scores per shift. There was no difference in early mobilization, length of stay, and complications. At 6-day follow-up (IQR 5-9), similar percentages of patients reported use of pain medication, and no opioids in the B-ESpB group. In the B-ESpB patients with smartwatch, there was no correlation of OME or pain score with measures of heart rate variability or steps taken prior to discharge. There was a mild correlation (R=0.28) between OME and ratio of REM vs. total sleep (p=0.10).
Conclusion: B-ESpB are safe in children undergoing cardiac surgery. When B-ESpB is performed as part of a multimodal pain strategy in an ERAS program, pediatric patients experience good pain control and require fewer opioids in the first 48 hours however, there was no impact on length of stay.
PERIOPERATIVE CARE:
Critical Care (Cardiogenic Shock (non-MCS), All Post-operative Care)
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