Comparison of intraoperative and postoperative effectiveness of ultrasound guided erector spinae plane block and patient controlled analgesia in patients undergoing coronary artery bypass grefting surgery with sternotomy

The aim of our study is to compare the bilateral erector spinae plane block (ESPB) efficacy on pain management with patient controlled analgesia (PCA) during perioperative period in patients scheduled for coronary artery bypass surgery (CABS) with sternotomy. After the ethics committee approval of our hospital, ASA II-III, 50 patients aged between 18-80 years were included. They were randomly divided into two groups, ESPB (n=25) and control (n=25). In the preoperative period, bilateral ESPB with ultrasonography was applied to both groups with 0.25% bupivacaine (3mg/kg)+dexamethasone (8mg) or saline, respectively. PCA prepared with morphine was given to all patients postoperatively. Perioperative opioid use, extubation times, coughing and resting Visual Analog Scale scores(VAS), duration for the first PCA bolus dose requirement, rescue analgesia needs, mobilization times, opioid side effects, and patient/surgeon satisfaction were evaluated. In the ESPB group, compared to the control group, intraoperative fentanyl consumption was lower (p=0.001), and extubation time was shorter (p=0.001). The VAS scores at the postoperative 0,1,2,4,8,12,16,24 hours were lower (p<0.05). In the ESPB group, it was found the first PCA use was later, the morphine consumption and the need for rescue analgesia was less than the control group (p<0.001,p<0.001,p=0.009, respectively). Opioid-related side effects were more common in the control group (p=0.040). The first mobilization time in the ESPB group patients was earlier (p<0.001). Patient and surgeon satisfaction was higher in the ESPB (p<0.001, p<0.001). As a result, ESPB has a significant analgesic effect in CABS patients. It was concluded that bilateral ESPB reduces the opioid requirement in the perioperative period compared to intravenous morphine PCA and provides better pain management and more comfortable recovery in the postoperative period. Key words: Erector spinae plane block, patient controlled analgesia; pain management, coronary artery bypass surgery