Safety and Effectiveness of Bilateral Erector Spinae Plane (ESP) Block in management of Acute Post operative surgical pain in pediatric cardiac surgeries via midline sternotomy.

Ultrasound– guided Erector spinae Plane (ESP) block is a novel, yet simpler and promisingregional anesthetic technique for post-operative analgesia that produces anextensive multidermatomal sensory block. The dorsal and ventral rami of thethoracic spinal nerves along with rami communicantes are its site of action.The ESP block, when given bilaterally at the level of   T5 spinous process, provides completeanalgesia from T2-T9 sensory level for about 12 hours on average.  Further, it is less invasive, safer, easierand quicker to perform, with rare to very rare occurrence of complications likepneumothorax. This block results in both somatic andvisceral analgesia3.

  Thus, ESP block could provide adequate andreliable analgesia for all the patients undergoing cardiac surgery via midlinesternotomy. Till date no research has been done regarding the role of ESP blockfor postoperative analgesia in pediatric cardiac surgical patients.

All preoperative cardiacmedication will be continued until the morning of surgery except antiplatelate,anticoagulant drugs. Premedication for children > 5kg will consist of 0.1mg/kg morphine and 0.5 mg/kg promethazine intramuscularly 1 hour before thesurgery. Children <5 kg receive no premedication as per institutionalprotocol. After coming to operative room, initial monitoring will include a5-lead electrocardiogram, Noninvasive blood pressure, and pulse oxymetry.Anesthetic induction will performed with Sevoflurane with oxygen and air, 50%each. Anesthesia will supplemented with intravenous midazolam, 0.05 to 0.1mg/kg; fentanyl 2 mcg/kg and rocuroneum 0.8 mg/kg. The maintenance will beachieved with midazolam, fentanyl, sevoflurane and atracurium as required.

Following measurements will be obtained for each patient. Thehemodynamic parameters – Heart rate and Blood pressure (Systolic, Diastolic andmean) will be measured as baseline, after induction of anaesthesia. Intraoperativemonitoring will be continued. After completion of surgery and administering theblock, hemodynamic parameters noted and patient will be shifted to ICU withendotracheal tube in situ. Extubation time, monitoring of pulse rate, bloodpressure SpO2, ECG, Respiratory rate and Modified objective pain score (MOPS)will be recorded in ICU every 2 hours for 12 hours after surgery.