Erector Spinae Plane (ESP) Block With 20 ml Versus 30 ml in Cardiac Surgery
Condition: Cardiac Surgery; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Even though erector spinae plane (ESP) block is shown to be efficient in cardiac surgery, it
      is still controversial how much volume is necessary for efficient analgesic effect for
      sternotomy and drain tube pain relief. This study aims to investigate the optimal local
      anesthetic volume (20 mL versus 30 mL) with ESP block for open-heart cardiac surgery.
    

Detailed description: 
      In cardiac surgery, the most common cause of pain during the first two days postoperatively
      is median sternotomy. In a study in which 705 patients who had undergone cardiac surgery were
      followed up prospectively, postoperative 24 hours pain scores ranging from 5.3 to 6.5 out of
      10 with deep breathing and coughing were shown. In these patients, it may increase the
      frequency of atelectasis due to reasons such as failure in pain control, weak coughing, and
      limitation of movement, and these may lead increase in morbidity and hospital stay. Although
      nonsteroidal analgesics and opioids are used successfully in the control of this severe pain,
      they are far from being ideal analgesics alone due to their side effects such as kidney
      damage, bleeding risk, sedation, respiratory depression, itching, nausea, and vomiting. The
      complications of neuraxial techniques seem to be the disadvantages of these methods. Erector
      spinae plane (ESP) block is one of the regional anesthesia techniques that has been shown to
      be effective in reducing sternotomy pain in sternotomy-guided cardiac surgeries.

      The Erector spinae plane (ESP) block was first described by Forero in 2016. In this block
      technique, a local anesthetic is given to the plane between the erector spinae muscle and the
      vertebral transverse process. The dorsal and ventral branches of the spinal nerves are
      blocked in this plane. However, due to individual regional anatomical differences, there is
      not enough data to determine the optimum volume at which the appropriate spread of local
      anesthetic will occur. Volume-based cadaver studies have some handicaps since they do not
      have the characteristics of living tissue.

      This study aims to compare the postoperative analgesic efficacy of ESP block applied at the
      same dose but with different local anesthetic volumes in cardiac surgeries to be performed
      with sternotomy.
    

Intervention name(s): bilateral erector spinae plane block with 30 mL 0.25 % bupivacaine; bilateral erector spinae plane block with 20 mL 0.25 % bupivacaine
Intervention type(s): Procedure; Procedure
Intervention description(s): Preoperative, awake, bilateral, ultrasound-guided erector spinae plane block with 30 mL 0.25 % bupivacaine; Preoperative, awake, bilateral, ultrasound-guided erector spinae plane block with 20 mL 0.25 % bupivacaine
Other intervention name(s): 30 mL; 20 mL
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: erector spinae plane block; local anesthetic volume; bupivacaine; sternotomy