Ultrasound-Guided Erector Spinae Plane Block Versus Thoracic Epidural Analgesia: Postoperative Pain Management After Nuss Repair for Pectus Excavatum
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Read the article on jpedsurg.org ↗Article · Oct 2021 · 1 min read
In brief
In brief
Comparative study of 30 patients demonstrates ultrasound-guided erector spinae plane block as a safe alternative to thoracic epidural analgesia for post-Nuss repair pain control. Despite slightly higher initial pain scores, ESPB patients achieved nearly one day shorter hospital stays with outpatient catheter management, avoiding neurologic complications associated with traditional methods.
Written by the GCMD Library team from the article.
Aim of the Study
Postoperative pain management is a significant challenge in patients undergoing Nuss repair for pectus excavatum chest wall deformity. Therapeutic anesthetic options primarily include patient-controlled analgesia, thoracic epidural analgesia (TEA), and cryoanesthesia. However, TEA is limited to in-patient use and both TEA and cryoanesthesia can result in neurologic injury. The novel technique of ultrasound-guided erector spinae plane regional analgesia has been used recently in our patients undergoing the Nuss repair and has shown impressive pain relief, but without the potential complications of other modalities. Erector spinae plane block (ESPB) postoperative pain management outcomes were studied as compared to TEA.
Methods
Thirty consecutive patients with severe pectus excavatum undergoing Nuss repair and placement of ultrasound-guided ESPB were each paired to a historical cohort control patient with TEA postoperative pain management. The cohort patient match was defined by age (±2 years), gender, and CT pectus index (±15%). Study variables included hospital length of stay (LOS), pain scores, and pain medication usage.
Results
Pain scores as measured by area under the curve (Day 1: 2.72 (SD=1.37) vs. 3.90 (SD=1.81), P = 0.006; Day 2: 2.83 (SD=1.32) vs. 3.97 (SD=1.82), P = 0.007) and oral morphine equivalent (OME) pain medication usage (Day 1: 11.9 (SD=4.9) vs 56.0 (SD=32.2), P < 0.001; Day 2: 14.7 (SD=7.1) vs. 38.0 (SD=21.7), P < 0.001) were higher for the first two postoperative days in the ESPB. However, mean hospital LOS was nearly one day shorter for ESPB patients (3.78 (SD=0.82) vs. 2.90 (SD=0.87), P < 0.001) who were discharged home with the catheter in place until removal, typically at 5-7 days postoperatively.
Conclusion
Ultrasound-guided ESPB is thus a feasible, safe, and effective alternative to TEA in postoperative pain management after Nuss repair and results in decreased hospital stay.