Use of erector plane block in heart surgery: review of clinical trials

Abstract

Background: One of the recently documented modalities of fascial plane block is the erector spinae plane (ESP) block, which was first described for the treatment of chronic thoracic neuropathic pain and postoperative pain in thoracic surgery. Since then, the technique has been used for a wide variety of clinical scenarios, including cardiac surgery. Aim: Through a review of clinical trials, to synthesize and evaluate the use of ESP block in cardiac surgery.

Method: This is an exploratory study, based on the method of literature review with evidence synthesis. The database chosen for the selection of papers was PUBMED, using the following search strategy: "erector spinae plane block" AND "cardiac surgery". Studies published in the last five years were evaluated, and any paper that discussed the proposed topic and was a clinical trial was initially included in the sample.

Results: Eleven studies were identified that met the previously established search strategy. After reading the titles and abstracts, one text was excluded because it was a letter to the editor.

Conclusion: For all papers evaluated, ESP block provided good analgesia and safety during and after cardiac surgical procedures, being superior to classic techniques such as thoracic epidural anesthesia (TEA) and intravenous analgesia with or without opiates. This data was also confirmed in pediatric surgeries. In addition, ESP block was responsible for the reduction of several adverse effects typical of the classical methods of analgesia mentioned, such as nausea, vomiting and longer periods of mechanical ventilation. Another interesting finding was the association of the technique with analgesia of the superficial parasternal intercostal plane and pectoral nerve block, which provided a reduction in the use of opiates, an increase in the satisfaction of patients undergoing ESP block and a decrease in pain scores.