ESP Block in Pediatric Patients for Postoperative Analgesia
Status:
Completed
Trial end date:
2021-04-01
Target enrollment:
Participant gender:
Summary
Pediatric cardiac surgery is associated with moderate to severe postoperative pain that is
related to median sternotomy. In a fast-track protocol, used in modern-day cardiac surgical
care, early extubation may be facilitated by effective postoperative pain control, which also
helps in maintaining hemodynamic stability This prospective, randomized, and double-blind
study is designed to examine the efficacy and safety of the ESP block on the postoperative
analgesia in pediatric patients after cardiac surgery.
40 pediatric patients aged 2-10 years, undergoing cardiac surgery with median sternotomy will
be enrolled. Children received oral premedication of midazolam 0.5 mg/kg. After i.v. access
will be obtained, fentanyl 5 µg/kg will be given. Anesthesia will be induced with 2-3 mg/kg
propofol and all children will receive rocuronium 0,6 mg/kg for tracheal
intubation.Subsequently, fentanyl 5 µg/kg will be administered prior to incision and an
additional 5 microg/kg of fentanyl given prior to CPB. Anesthesia will be maintained with
%2-3 sevoflurane. Fentanyl 1 µg/kg will be given before skin closure at the end of surgery.
Patients were randomly assigned to a study group by the computer generated number table.
Children in group B were administered bilateral ESPB with 0.25% bupivacaine, while children
in group C did not receive any intervention. Following inhalational induction and
endotracheal tube placement, the patient will be turned into a left lateral decubitus
position and bilateral ESP block will be performed under aseptic conditions.
ESP block at bilateral side will be performed in the lateral decubitis position and at T5
transverse process level by using 10-MHz liner ultrasound probe. The probe will be located 1
cm lateral to T5 spinous process in longitudinal parasagittal orientation. Simplex A 50mm
(B.Braun, Germany) will be inserted by using out of plane technique. The ESP blocks proceed
with 0,5 ml/kg of 0,25% bupivacaine (Group B).
Postoperative care: All the patients then will be shifted to the intensive care unit (ICU)
after the surgery and managed with the institution's ICU protocol for postoperative pain
management and ventilation.The postoperative analgesia will be provided with rescue
intravenous (IV) morphine 0.05 mg/kg. Both the groups will receive IV paracetamol 15 mg/kg
every 6 hours as a component of multimodal analgesia.
Postoperative sternal wound pain will be judged by the Modified Objectice Pain Scale.
Postoperative sedation levels will be evaluated with Ramsya sedation score.