BILATERAL EXTENDED ESPB AS A COMPONENT OF ERAS IN CARDIAC SURGERY
DOI:
https://doi.org/10.32782/2411-9164.24.1-7Keywords:
cardiac surgery, ERAS, multimodal analgesia, rectus abdominis plane block, complete longitudinal sternotomy, postoperative pain, opioidsAbstract
Introduction. Recently, the use of ESPB as a component of multimodal analgesia (MMA) in cardiac surgery has been introduced. However, the effect of ESPB on the speed of postoperative recovery in patients remains unclear. Aim. To evaluate the effectiveness of bilateral extended ESPB as a component of the rapid recovery after cardiac surgery (ERASC) program with median sternotomy. Materials and methods. The study included 217 patients who underwent cardiac surgery with median sternotomy with artificial blood circulation. The average age of patients was 60.6 ± 10.9 years. Patients were divided into: group 1 (n=76) – narcotic analgesics, paracetamol, lidocaine, ketorolac; group 2 (n=141) – ESPB, paracetamol, lidocaine, ketorolac, narcotic analgesics – as needed. Intraoperative fentanyl consumption, hemodynamic stability, systemic perfusion disorders (lactate level), systemic response to operative stress (glycemia level), time to tracheal extubation, postoperative pain intensity, postoperative use of narcotic analgesics, patient activation, length of stay in the intensive care unit (ICU) and hospital stay. For statistical processing, Statistica and Microsoft Excel 2013 packages were used. Results. Intraoperative fentanyl requirement was lower in group 2 than in group 1 (0.2 ± 0.05 mg vs. 1.02 ± 0.27 mg p=0.07). Hemodynamic parameters in group 2 remained more controlled and stable during surgery. Lactate at the end of the operation increased in both groups by 2.5 times (p<0.05) without a significant difference between groups (p=0.128). Glycemia also increased in both groups (p<0.05), but in group 2 it was significantly lower than in group 1 (8.4 ± 1.39 mmol/l versus 11.54 ± 2.16 mmol/l, respectively, p=0.0001). The time to tracheal extubation after surgery in the ESPV group was on average 315 minutes shorter than in the group without ESPV (p=0.0001) and was 47.53 ± 147.91 minutes. The intensity of pain according to VAS in group 2 was on average three times lower than in group 1 both immediately after surgery (p=0.00001) and within 48 hours after surgery (p=0.0001). Narcotic analgesics were prescribed to only 16 (11.3%) patients in group 2, compared to 60 (78.94%) patients in group 1 (p=0.00001). ESPV allowed patients to become active 15 hours earlier (p=0.00001), reduced ICU stay by 85 hours (p=0.00016), and hospital stay by 11 days (p=0.00001). Conclusions. The use of bilateral extended ESPV as a component of ERASC leads to a decrease in perioperative consumption of narcotic analgesics, early tracheal extubation, and a reduction in the time patients spend in the ICU and hospital.
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