Evaluation of a Peri-Operative Continuous Bilateral Erector Spinae Plane (ESP) Continuous Catheter After Open Cardiac Surgery in Adults

Methodology With the Approval of Ethical committee of VinMec Healthcare and after Patient's information and consent from guardian or parents, adults will be randomized via a random number generator into one of two treatment groups by the person who obtained consent which is prescribed in the nurse preparation file".

Group 1: will receive a single shot dose of local anesthetic Ropivacaine throw ESP catheters and 6 hours after continuous infusion of Iso saline with a rescue analgesia in case of pain according to the bellow protocol Group 2 :will received a single shot dose of local anesthetic Ropivacaine throw ESP catheters and 6 hours after a continuous infusion of Ropivacaine with a rescue analgesia if needed according to the bellow protocol Catheter Performance The anesthesia team will perform to all patients without exclusion criteria (Group I & II) for open heart surgery after the anesthesia induction a bilateral insertion of an Erector Spinae Plane Block catheter under ultrasound guidance.

Patient in right lateral decubitus. The anesthesiologist will use an Ultrasound linear probe at T4 level and identify the T4 transverse process. By hydro-dissection he will identify the inter-fascial space between the Inter-transverse ligament anteriorly and the Erector Spinae Muscle posteriorly to insert under ultrasound vision a catheter . The tip of the catheter should be at T5 Transverse level seen by ultrasound. The anesthesiologist check the right position of the catheter with a dextrose 5% injection = 1 to 3 mL under ultrasound vision and see the spread of the dextrose in the inter-fascial space which sign that the catheter is not intra-vascular. This procedure will be bilateral. The catheter will have a yellow label on the Huer®-Lock connector to identify clearly that it is regional analgesia catheter to prevent any errors of miss injection. (Yellow is the international identification of regional anesthesia analgesia lines).

After this control an induction low dose is injected. Table 1 Induction dose Patient 30 - 40 kg = 6 mL of Ropivacaine 0.5% / side Patient 40 - 50 kg = 8 mL of Ropivacaine 0.5% / side Patient 50 - 60 kg = 10 mL of Ropivacaine 0.5% / side Patient 60 - 70 kg = 12 mL of Ropivacaine 0.5% / side Patient > 70 kg = 14 mL of Ropivacaine 0.5% / side 5h after, the ESP catheter induction, prepare the solution in the pump The clinical research nurse specially trained for this study will proceed to the randomization of the patient according to the randomization table and prepare the solution in the pump as per attached protocol. They will put the number of patient's randomization on the pump. The nurse receives instruction to keep strictly confidential the content of the pumps. They will deliver the prepared pumps to the anesthesiologist and anesthesia nurse in charge of the patient. They will connect the pumps to the patient and start the infusion 6 hours after as per protocol.

Group 1 & Group 2 will have the blinded solution in the pump ♣ Table 2 Intermittent Automatic bolus For post operative ESP catheter infusion Patient 30 - 40 kg = 6 mL of Ropivacaine 0.5% / side/ 6h Patient 40 - 50 kg = 8 mL of Ropivacaine 0.5% / side/ 6h Patient 50 - 60 kg = 10 mL of Ropivacaine 0.5% / side/ 6h Patient 60 - 70 kg = 12 mL of Ropivacaine 0.5% / side/ 6h Patient > 70 kg = 14 mL of Ropivacaine 0.5% / side/ 6h (The bolus on the second catheter will be delayed by 1 hour).