Erector spinae plane block utilizing liposomal bupivacaine in pediatric cardiac surgery: A case report.

Abstract

Erector spinae plane blocks (ESPBs) have become more popular in cardiothoracic surgeries due to their safety, execution simplicity and efficient pain relief.1ESPBs utilizing the long-actingliposomal form of bupivacaine have shown promise in the reduction of prolonged pain and opioid use both during and after surgery.2Nonetheless, the use of liposomal bupivacaine in ESPBs in pediatric cardiothoracic surgeries remains minimally explored.3In this case, an ESPB with liposomal bupivacaine was used on a pediatric patient undergoing coronary artery unroofing on cardiopulmonary bypasswith the goal toreduce postoperative opioid requirements and pain scores.MethodsA seven-year-oldmale with a history of an anomalous left coronary artery arising from the right sinus of Valsalva underwent coronary artery unroofing on cardiopulmonary bypass. Before surgery, bilateral ESPBs utilizing1.3% liposomal bupivacaine (3mg/kg or 108mg) and 0.25% plain bupivacaine (2mg/kg or 73mg) wereperformed at the 5th thoracic vertebrae with the guidance of ultrasound(Figure 1). After the operation was completed, a field block, using a combination of 0.25% plain bupivacaine (0.25mg/kgor 9 mg) and 1.3% liposomal bupivacaine (1 mg/kg or 36 mg), was performed at the chest tube site. Post-operative pain scores, along with intraoperative and postoperative opioid consumption, were recorded within the first 48 hours.