Erector Spinae Blocks for opioid-sparing multimodal pain management after Pediatric Cardiac Surgery.

Objective Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate: the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery. Methods Patients ages 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery (ERAS) program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the ERAS program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling. Results Forty (40) patients receiving BESB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31-min. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalent (OME) than controls at 24-hrs (0.60±0.06 vs 0.78±0.04 mg/kg, p=0.02) and 48-hrs (1.13±0.08 vs 1.35±0.06 mg/kg, p=0.04), respectively. Both groups had low median pain scores per 12-hrs period. There was no difference in early mobilization, length of stay, and complications. Conclusion B-ESpB are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an ERAS program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.