Background
Erector spinae plane blocks (ESPBs) has become more popular in cardiothoracic surgeries due to their safety, execution simplicity, and efficient pain relief.1 In this case, an ESPB with liposomal bupivacaine was used on a pediatric patient undergoing coronary artery unroofing on cardiopulmonary bypass with the goal to reduce postoperative opioid requirements and pain scores.
Methods
A 7-year-old male 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 utilizing 1.3% liposomal bupivacaine (3mg/kg or 108mg) and 0.25% plain bupivacaine (2mg/kg or 73mg) was performed at the 5th thoracic vertebrae with the guidance of ultrasound. Post-operative pain scores were recorded along with intraoperative and postoperative opioid consumption within the first 48 hours.
Results
A total of 175 µg fentanyl (4.9 µg/kg) was administered throughout the operation. The pain scores after surgery ranged from 0 to 5 and were relatively low with an average of 1.0/10 (maximum pain score of 5), and 0.7/10 (maximum pain score of 4) on days 1, and 2 respectively.
Conclusion
This case suggests that ESPBs utilizing liposomal bupivacaine has great potential in improving postoperative pain and lowering overall opioid requirements amongst pediatric patients undergoing heart surgery.