Ultrasound-Guided Erector Spinae Plane Block: A Comparative Study to Assess its Analgesic Efficacy in Pediatric Patients Undergoing Aortic Coarctation Repair

Background: Effective postoperative analgesia is an important aspect of both anesthetic practice and postoperative outcomes. Thoracotomy for the repair of coarctation of the aorta is a painful surgical procedure; inadequate postoperative analgesia may result in postoperative respiratory complications with the possible prolonged need for oxygen therapy. In addition, paradoxical hypertension is a well-recognized complication of repair. We hypothesize that erector spinae plane block (ESPB) by providing adequate analgesia and blocking sympathetic stimulation may reduce opioid consumption, accelerate weaning of oxygen therapy, and reduce the incidence of early postoperative paradoxical hypertension. Material and methods: Open-labeled randomized controlled trial carried out on 40 patients divided into two groups. Group (B) received ESPB before the skin incision and group (C), the control group received no block. Results: Patients who received ESPB had significantly less intraoperative fentanyl consumption than the control group (P-value<0.001), and significantly less postoperative fentanyl consumption by 50% than the control group in the first 12 hours 2.025 ±0.273 μg/kg and 4.05 ±0.527 μg/kg respectively (P-value<0.001). while there was no statistically significant difference between both groups regarding the incidence of postoperative vasodilator infusion for paradoxical hypertension (P-value=0.054), the pediatric anesthesia emergence delirium (PAED) (P-value=0.06) nor the time to wean oxygen supply (P-value=0.49).  Conclusion: Erector spinae plane block effectively reduces postoperative pain in pediatric patients undergoing repair of coarctation of the aorta. However, it did not significantly accelerate weaning from oxygen therapy nor reduce the incidence of vasodilator use for postprocedural hypertension