bilateral erector spinae plane block for management of acute postoperative pain after pediatric cardiac surgeries through a midline sternotomy

Conditions: Cardiac Surgery

Summary: many analgesic modalities have been investigated in pediatrics. the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in pediatric patients undergoing open midline sternotomy will be examined. methods: 60 patients aged 3- 12 years will be randomly assigned into two groups: control group will receive general anesthesia with bilateral sham erector spinae plane block at the level of t6 transverse process using 0.3 ml/kg normal saline on each side. erector spinae plane block group will receive bilateral ultrasound-guided erector spinae plane block at the level of t6 transverse process using 0.3 ml/kg bupivacaine 0.25% (on each side) with a maximum dose of 2 mg/kg. the postoperative pain was assessed using modified objective pain scores (mops) which will be evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours after extubation, total consumption of intraoperative fentanyl (1µg/kg iv in case of inadequate analgesia), time to first rescue analgesic administration and postoperative paracetamol consumption will be recorded over the first 24 hours postoperatively.

75 children with an american society of anesthesiologists physical status class i and ii undergoing cardiac surgical procedures through midline sternotomy . the patients with preoperative ejection fraction \ 480 seconds before the initiation of cardiopulmonary bypass in both the groups. after a satisfactory surgical correction, the patient will be weaned off cardiopulmonary bypass followed by protamine administration. the patients will be transferred to the intensive care unit (icu) after completion of the procedure. postoperative icu management and postoperative pain assessment the electrocardiogram, invasive blood pressure, respiratory rate, and pulse oximetry (spo2) were monitored and recorded throughout the postoperative period. the study subjects will be extubated within 2 to 3 hours postoperatively once the exubation criteria (conscious, hemodynamically stable, (peak inspiratory pressure) pip \<20 cmh2o above positive end-expiratory pressure (peep)will be fulfilled, no neuromuscular blockade, and normal arterial blood gas analysis). postoperative pain assessment will be performed using modified objective pain score (mops)9 at 0, 1, 2, 4, 6, 8, 10, and12hours post extubation. acetaminophen, 15 mg/kg, iv, every 8 hours will be administered in both the groups. . a rescue analgesic fentanyl, 0.5 to 1 mg/kg, will be administered when the mops score was≥ 4 at rest. postoperative adverse effects such as nausea, vomiting, cardiac arrhythmia, and complications such as la toxicity, and vascular puncture were recorded and treated. statistical analysis primary and secondary endpoints mops at 0, 1, 2, 4, 6, 8, 10, and 12 hours post extubation constituted the primary endpoints. the secondary endpoints will include intraoperative fentanyl requirement, extubation time, time to first rescue analgesic requirement, postoperative cumulative fentanyl requirement up to 12 hours, ramsay sedation score, icu stay, and incidence of adverse events.

Eligibility criteria:
inclusion criteria: * children undergoing cardiac surgical procedures through midline sternotomy exclusion criteria: * the patients with preoperative ejection fraction \<35% * allergic to the amide type of local anesthetics (la) * preoperative inotropic support