Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery

Kukreja, P; Herberg, TJ; Johnson, BM; Kofskey, AM; Short, RT; MacBeth, L; Paul, C; Kalagara, H; Herberg, T; Johnson, B; Paul, CA

Journal article

Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery

Abstract:: Background: Cardiac surgery is associated with significant postoperative pain, traditionally managed with opioids and epidural techniques. The erector spinae (ESP) block, providing analgesia to the anterior, lateral, and posterior chest wall, is described as a simplistic safe alternative to the thoracic epidural (TEA) or paravertebral block (PVB) for cardiacpatients . The literature suggests that its minimal risk of vascular puncture, hypotension, or local anesthetic toxicity and superior postoperative pain scores enhance patient recovery after cardiac surgery. This doctoral project aimed to answer the PICO question: In adult cardiac surgical patients, is the use of the erector spinae block, compared to the paravertebral block or thoracic epidural analgesia, effective in decreasing postoperative pain and complications? Methods: The proposed project\u27s primary approach is to engage anesthesia providers with an online educational intervention that emphasizes the advantages of the ESP block for cardiac surgery. The improvement in providerknowledge before and after the intervention was measured using pre- and post-assessment surveys. There will also be an evaluation of the ESP block\u27s likelihood of use and recommendation for heart surgery. Results: The educational intervention led to a general enhancement in provider knowledge. Overall, the probability of using and endorsing the ESP block increased. Conclusion: Inadequate postoperative pain management is linked to increased morbidity and mortality. The impact ofenhanced recovery after surgery and fast-tracking protocols necessitates implementing effective multimodal techniques. The ESP block offers a cost-effective alternative for the cardiac surgery patient compared to the thoracic epidural and paravertebral block. The ESP block was found to have comparable pain control or better pain control with fewer adverse effects. Implementation of the ESP block as a multimodal analgesic strategy in the cardiac surgical patient can enhance recovery after cardiac surgery. Its favorable safety profile is a cost- effective alternative to the TEA and PVB

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Kukreja, P., Herberg, T. J., Johnson, B. M., Kofskey, A. M., Short, R. T., MacBeth, L., Paul, C., Kalagara, H., Herberg, T., Johnson, B., & Paul, C. A. (2021). Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery. Cureus: Journal of Medical Science, 13(10), e18533–e18533.

MLA Style

Kukreja, P, et al. “Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery.” Cureus: Journal of Medical Science, vol. 13, no. 10, 2021, pp. e18533–e18533.

Chicago Style

Kukreja, P, TJ Herberg, BM Johnson, et al. 2021. “Retrospective Case Series Comparing the Efficacy of Thoracic Epidural With Continuous Paravertebral and Erector Spinae Plane Blocks for Postoperative Analgesia After Thoracic Surgery.” Cureus: Journal of Medical Science 13 (10): e18533–e18533.
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