Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery-A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial

• Published in: Medicina (Kaunas, Lithuania) Vol. 59; no. 2; p. 265
• Main Authors: Balan, Cosmin, Tomescu, Dana R, Bubenek-Turconi, Serban I
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-01-2023; MDPI
• Subjects: Adult; analgesia; Analgesics, Opioid; Anesthesia; Anesthesia, General; Biometrics; Cardiac Surgical Procedures; Clinical trials; Coronary artery bypass; Darbepoetin alfa; Disease prevention; Dosage and administration; erector spinae plane block; Extubation; Fentanyl; General anesthesia; Heart surgery; Hemodynamics; Humans; Medical research; Medicine, Experimental; Morphine; Narcotics; Nerve Block; Nociception; nociception level index; nociception monitoring; open heart surgery; Pain, Postoperative; Patients; Recovery (Medical); Romania; United States > US; Israel; erector spinae plane block; nociception monitoring; open heart surgery; nociception level index; analgesia
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina59020265

The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index.
This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control,
= 43) and group 2 (ESPB,
= 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli.
The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (
< 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (
< 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (
< 0.001).
The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation.