205. Erector Spinae Blocks are Opioid-Sparing in Pediatric Patients After Congenital Cardiac Surgery.
Nemours Children's Health, Florida
Orlando, FL
United States - Contact Me
Dr. Jennifer Nelson is a congenital heart surgeon at Nemours Children's Health in Orlando, FL and Professor of Surgery at the University of Central Florida College of Medicine. Dr. Nelson's clinical interests include surgery for tetralogy of Fallot, aortic valve disease in children and young adults, and Ebstein's anomaly. In addition to publishing on these topics, Dr. Nelson's research focuses on congenital heart surgery outcomes, particularly utilizing the STS National Databases. Dr. Nelson holds several Society leadership positions and recently served as the Chair of the STS Workforce on the Surgical Treatment of Adults with Congenital Heart Disease and led the development of the STS Adult Congenital Heart Disease mortality risk model. She is the former Resident Director to the STS Board of Directors, and currently serves on the Workforce for National Databases. Dr. Nelson is an AATS member and participated in the AATS Congenital Clinical Practice Standards Committee Writing Group on Fast Track Extubation and Postoperative Sedation, and she is the current Chair of the STS Congenital Writing Group composing Clinical Practice Guidelines for Indications and Timing of Pulmonary Valve Replacement Following Repair of Tetralogy of Fallot.
Boston Children's Hospital
Boston, MA
United States - Contact Me
Dr. Nathalie Roy is a Fellow of the Royal College of Surgeons of Canada in Cardiac Surgery and Board Certified in Critical Care. She Graduated from Laval University Faculty of Medicine where she trained in General Surgery, followed by a residency in Cardiac Surgery at McGill University, with fellowships in Congenital Cardiovascular Surgery from the Hospital For Sick Children and the University of Toronto, UCSF, Stollery Children's Hospital and Boston Children's Hospital. Her critical care training was at Brigham and Women's Hospital. Dr. Roy's clinical interests focus on surgical critical care of the pediatric and adult patient with congenital heart disease, acute mechanical circulatory support (MCS), and thoracic transplantation. She is the Director of Cardiac Surgery Critical Care at Boston Children's Hospital and is involved in the training of fellows in the CICU.
Dr. Roy led the development and implementation of an Ehanced Recovery after Congential Cardiac Surgery program, a large heart center quality improvement initiative at Boston Children's Hospital, Her research was funded by a surgical investigator award from the AATS foundation. She and her colleagues have authored many publications and presented the program outcomes at national and international conferences. Dr. Roy was an active member of the 2021 American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group consensus document on a comprehensive approach to enhanced recovery ater pediatric cardiac surgery published in the Journal of Throacic and Cardiovascular Surgery. She became a member of the AATS in 2022.
Abstract
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.