Erector spinae plane block for enhanced recovery after cardiac surgery in minimally invasive mitral valve surgery

Introduction Adequate postoperative analgesia is essential for Enhanced Recovery After Cardiac Surgery (ERACS). Regional anaesthesia facilitates the recovery process following minimally invasive mitral valve surgery (MIMVS). Aim of this retrospective study was to assess the efficacy of a continuous Erector Spinae Plane Block (ESP) in Minimally Invasive Mitral Valve Surgery (MIMVS) with regard to postoperative pain, opioid consumption and recovery. Methods Data of 34 consecutive patients who underwent ERACS for MIMVS between 1st March 2018 and 21th March 2019 were collected and analyzed. The ESP group (n=19) received ESP, the control group (n=15) received local wound infiltration. We analyzed the following parameters: postoperative morphine consumption in the post anesthesia care unit (PACU), need for analgesics at hospital ward, numerical rating scale (NRS) for pain, incidence of postoperative nausea and vomiting (PONV), duration of mechanical ventilation, incidences of pericarditis and acute kidney failure, need for intensive care unit (ICU) admittance and length of hospital stay. Results Compared to control, patients in the ESP group required a similar dosage of morphine with, however, a reduced NRS for pain following extubation (2±3 vs 4±3; p = 0,0344). In addition, NRS for pain was significantly lower on the second day after surgery (3±2 vs 4±2; p = 0,008). ESP was associated with a reduction of PONV (2,5±2,7 vs 4,7±3,8; p = 0,024). Duration of postoperative acetaminophen requirements was shorter in the ESP group (4,2±2,1 vs 5,3±1,2days; p = 0,045). One patient of the control group had a third-degree AV-block and another patient of the control group had respiratory insufficiency, both were admitted to the ICU. Discussion All results indicate a favorable effect of the ESP block on analgesia with lower pain scores and a reduction in PONV incidence as compared to the control group. Incidence of adverse events did not differ between the groups. Further studies in a larger population are warranted in order to demonstrate a statistically significant reduction in postoperative opioid consumption.