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Can ultrasound-guided erector spinae plane block replace thoracic epidural analgesia for postoperative analgesia in pediatric patients undergoing thoracotomy? A prospective randomized controlled trial


Department of Anesthesiology and Intensive Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Correspondence Address:
Swati Singh
Department of Anesthesiology and Intensive Care, First Floor, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_269_20

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Year : 2022  |  Volume : 25  |  Issue : 4  |  Page : 429-434

 

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Background: Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound-guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy. Materials and Methods: A prospective, randomized, observer-blinded, controlled study. Pediatric patients (2–7 years) scheduled for right or left thoracotomy under general anesthesia (GA) were enrolled in the study. We randomly assigned patients into two groups: The thoracic epidural analgesia (TEA) group received GA with an epidural catheter. The ESPB group received GA with a unilateral ultrasound-guided erector spinae plane catheter. The primary outcome was postoperative cumulative opioid consumption for 24 h. Results: The total intraoperative fentanyl requirement was 35.4 ± 11.44 μg in the TEA group and 30.4 ± 9.08 μg in the ESPB group (t-value − 1.53013, P value: 0.134). The total postoperative fentanyl requirement was comparable in both the groups and clinically nonsignificant (44 ± 2.82 in the TEA group vs. 44.25 ± 13.72 in the ESPB group, t-value = −0.02412, P = 0.981). The median (IQR) Face, Legs, Activity, Cry, and Consolability (FLACC) score at 0, 2, 4, 8, 12, and 24 h time points in the ESPB was equivalent to the TEA group. At 6 h time point, the TEA group had a significantly lower FLACC score than the ESPB group (1[1.75, 1] in the TEA group and 2 [2, 1] in the ESPB group, P value = .02, U = 117.5, z-score = −2.218). The complications were higher in the TEA group (urine retention 20% and hypotension 40%) than in the ESPB group (0 and 0%). Conclusions: This study shows that the ESPB provides similar postoperative analgesia to the TEA in pediatric patients undergoing thoracotomy. The ESPB is simpler, faster, and has a lower complication rate.






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Department of Anesthesiology and Intensive Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Correspondence Address:
Swati Singh
Department of Anesthesiology and Intensive Care, First Floor, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_269_20

Rights and Permissions

Background: Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound-guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy. Materials and Methods: A prospective, randomized, observer-blinded, controlled study. Pediatric patients (2–7 years) scheduled for right or left thoracotomy under general anesthesia (GA) were enrolled in the study. We randomly assigned patients into two groups: The thoracic epidural analgesia (TEA) group received GA with an epidural catheter. The ESPB group received GA with a unilateral ultrasound-guided erector spinae plane catheter. The primary outcome was postoperative cumulative opioid consumption for 24 h. Results: The total intraoperative fentanyl requirement was 35.4 ± 11.44 μg in the TEA group and 30.4 ± 9.08 μg in the ESPB group (t-value − 1.53013, P value: 0.134). The total postoperative fentanyl requirement was comparable in both the groups and clinically nonsignificant (44 ± 2.82 in the TEA group vs. 44.25 ± 13.72 in the ESPB group, t-value = −0.02412, P = 0.981). The median (IQR) Face, Legs, Activity, Cry, and Consolability (FLACC) score at 0, 2, 4, 8, 12, and 24 h time points in the ESPB was equivalent to the TEA group. At 6 h time point, the TEA group had a significantly lower FLACC score than the ESPB group (1[1.75, 1] in the TEA group and 2 [2, 1] in the ESPB group, P value = .02, U = 117.5, z-score = −2.218). The complications were higher in the TEA group (urine retention 20% and hypotension 40%) than in the ESPB group (0 and 0%). Conclusions: This study shows that the ESPB provides similar postoperative analgesia to the TEA in pediatric patients undergoing thoracotomy. The ESPB is simpler, faster, and has a lower complication rate.






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