Erector Spinae Plane Block and Pain Management in Cardiac Surgery
Condition: Cardiac Surgery; Adult
Study type: Interventional

Summary: 
      Evaluation of the benefit effects of Peri-Operative analgesia by Continuous Bilateral Erector
      Spinae Plane block(ESP) for Open Cardiac Surgery: A case series prospective study with a
      comparison a retrospective case series (Before and after)
    

Detailed description: 
      After Patient's information and consent from the Ethical committee of VinMec Healthcare
      (#06/2017/HDD-VMEC) the anesthesia team will perform to all adult patients for open heart
      surgery after the anesthesia induction a bilateral insertion of an Erector Spinae Plane Block
      catheter under ultrasound guidance The Block performance :

      Patient in right lateral decubitus. The anesthesiologist will use an high-frequency linear
      ultrasound transducer sagitally at T4 level to identify the lateral extremity of the T4
      transverse process (Logic E GE USE). After inserting in plane a Tuohy needle 80 mm 18G the
      anesthesiologist will locate the tip of the needle and confirm by hydrodissection the
      inter-fascial space between the inter-transverse ligament anteriorly and the fascia of the
      Erector Spinae Muscle posteriorly . He will insert under ultrasound vision a catheter
      (Perifix B.Braun Germany) . The anesthesiologist check the right position of the catheter
      with a dextrose 5% injection = 2mL under ultrasound vision and see the spread of the Dextrose
      between in the inter-fascial space. This procedure will be bilateral. The catheter will have
      a yellow label on the Huer®-Lock connector to identify clearly that it is regional analgesia
      catheter to prevent any errors in these patients will a lot of catheters.

      After this control an induction dose of Ropivacaine (0.5%) 0.25mL/Kg is injected in each
      catheter ( Loading dose).

      8 h after a automatic infusion of Ropivacaine (0.2%) will be infused throw the 2 ESP
      catheters the infusion regimen will be Intermittent automatic bolus every 6h. on each
      catheter. The bolus on the second catheter will be delayed by 1 hour to minor the maximal
      plasmatic concentration.

      Volume of the bolus:

      For 40 to 50 kg patient the volume of intermittent automatic bolus will be 6 mL/ 6H/ Side For
      50 to 60 kg patient the volume of intermittent automatic bolus will be 8 mL / 6H/ Side For 60
      to 70 kg patient the volume of intermittent automatic bolus will be 10 mL / 6H/ Side For a 70
      kg and > 1.70 m Patient the volume of intermittent automatic bolus will be 12 mL / 6H/ Side

      If the block extension is not enough additional bolus by clinician only of 8 mL maximum 3 per
      day and 1 hour after the last automatic bolus delivered

      If the analgesia is not efficient after 1 additional bolus the catheters will be removed and
      we will prescribe the classical IV analgesia as before.

      The regional analgesia will be up to 4 hours after mediastinal drain removal and a maximum of
      76h. after catheter incision

      A Bi Daily inspection of the catheters insertion points will be done. If redness around
      puncture point the catheters will be removed and shift to classical IV analgesia to prevent
      any infection.

      The criteria studied will be:

      Consumption of opioids at 48h Variation of Blood pressure during sternotomy Level of pain at
      rest and mob after the surgery Time to extubate the patient Early mobilisation after surgery
      the quality of thorax expansion Level of pain 1 month after the surgery and limited activity
      at one month

      The control group was an historical group of twenty consecutive patients, operated by the
      same surgeons from June 8th 2017 and August 1th 2017 and matched with the studied group, in
      which data were noted just before the introduction of ESB in the ERAS program. All data from
      the control group come from the centralized computer network of patient records at Vinmec
      University Hospital.
    

Intervention name(s): Ropivacaine
Intervention type(s): Drug
Intervention description(s): ESP catheter
Other intervention name(s): ESP catheter
Intervention MeSH terms: Ropivacaine
Intervention model: Single Group Assignment
Intervention model description: Prospective series case compared to a before group of consecutive patients
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Bilateral ESP Catheter; Open heart surgery; opioid free post op analgesia