The Effect of Bilateral Erector Spina Plane Block on Postoperative Pain in Adult Cardiac Surgery.
Condition: Postoperative Pain; Opioid Use
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Failure to adequately prevent pain after heart surgery increases morbidity and results in a
      high incidence of persistent poststernotomy pain syndrome. Aim in this study is to
      investigate analgesic consumption and postoperative pain effect in patients who underwent
      cardiopulmonary bypass with Erector Spinae Block, a new block.
    

Detailed description: 
      Failure to adequately prevent pain after heart surgery increases morbidity and results in a
      high incidence of persistent poststernotomy pain syndrome.

      The use of special opioid-based analgesia causes adverse effects such as nausea, vomiting,
      sedation, urinary retention, respiratory depression and delayed tracheal extubation.

      Regional anesthesia techniques such as pectoralis nerve block and serratus anterior block
      provide analgesia in the sternum and protection from pain in the lateral / posterior chest
      wall.

      Ketamine and a2 agonists were used for intravenous analgesia to reduce opioid consumption.
      However, these drugs have potential side effects that limit their extensive clinical use as
      analgesic agents. The use of regional anesthetic techniques, e.g. thoracic epidural and
      thoracic paravertebral block, dural puncture, epidural hematoma, spinal cord injury,
      hypotension, pneumothorax, epidural abscess, ipsilateral Horner's syndrome Their use has
      declined due to the high failure rate of as much as 15% (especially for the thoracic
      epidural) and the significant possibility of complications.

      Erector spinae (ESP) block, a new method, provides a wide multi dermatomal sensory block. In
      the T 4-5 spinous process, the bilateral ESP block provides analgesia from T2 to T9 sensory
      level and results in both somatic and visceral analgesia by blocking both the dorsal and
      ventral of the spinal nerves, including the sympathetic chain. This block can provide
      sufficient analgesia for the median sternotomy because the main nerve supply to the sternal
      region is from T2 to T6. Our aim in this study is to investigate analgesic consumption and
      postoperative pain effect in patients who underwent cardiopulmonary bypass with Erector Spina
      Block, a new block.
    

Intervention name(s): Erector Spinae Plane Block
Intervention type(s): Procedure
Intervention description(s): A high-frequency ultrasound linear probe, covered with a sterile sheath, will be placed approximately 2 cm to the right or left of the T 4-5 spinous process. After showing the T 4-5 transverse process and the erector spinae muscle on top of it, a 22-gauge, 80 mm insulated quincke type needle will be inserted into the skin at an angle of approximately 30 degrees from cranial to caudal, using the in-plane technique. When the transverse process is touched, the needle will be pulled out and after a negative aspiration test with 0.5 mL of normal saline and after the demonstration of a hypo-echogenic image and hydro dissection, a local anesthetic solution will be applied to the fascia beneath the erector spinae muscle. A 20 mL dose of 0.25% bupivacaine, which has been shown to spread both above and below the T 4-5 level, will be injected.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Care Provider)
Primary purpose: Prevention