Efficacy of Erector Spinae Plane Block (ESPB) in pediatric cardiac surgeries: a systematic review and meta-analysis
Eficácia do bloqueio do plano eretor da espinha (BPEE) em cirurgias cardíacas pediátricas: uma revisão sistemática e meta-análise
Verônica Pustrelo Damião, Priscila Pechim Andrade, Leonardo Saraiva Guimarães de Oliveira, Angélica de Fátima Assunção Braga, Vanessa Henriques Carvalho
Abstract
Background
Erector Spinae Plane Block (ESPB) effectively reduces pain scores for sternotomy in adults. However, evidence is insufficient to assert that the same result occurs in children. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ESPB in pediatric cardiac surgeries.
Methods
Systematic Medline, Embase and Cochrane searches were conducted for studies that compared ESPB versus no block or sham block for pediatric cardiac surgery under sternotomy. The primary outcome was cumulative opioid consumption for up to 48 hours. Statistical analyses were carried out with the use of RStudio version 1.2.1335. Heterogeneity was assessed by Cochran's Q test and I2 statistics. Quality assessment and risk of bias assessment complied with Cochrane recommendations.
Results
Five studies, involving 328 patients (3 Randomized Controlled Trials [RCT], and 2 cohorts) were included. Of the 328 patients, 160 (48.7%) underwent ESPB. There were significant reductions in cumulative opioid consumption up to 48 hours after ESPB (SMD -0.68; 95% CI -1.13 – -0.23; p < 0.01). In the following outcomes ESPB failed to show superiority: postoperative nausea and vomiting (OR = 0.56; 95% CI 0.25–1.23; p = 0.54), fever (OR = 0.75; 95% CI 0.24–2.31; p = 0.58), length of intensive care unit stay in hours (MD -2.42; 95% CI -5.47–0.64; p < 0.01] and length of hospital stay in days (MD -0.87; 95% CI -2.69–0.96; p = 0.02). Only one cohort study had a high risk of bias.
Conclusion
ESPB potentially reduces postoperative pain by significant reductions in cumulative opioid consumption up to 48 hours in pediatric cardiac surgery patients.
Keywords
Resumo
Introdução
O bloqueio do plano eretor da espinha (BPEE) reduz efetivamente os escores de dor para esternotomia em adultos. No entanto, as evidências são insuficientes para afirmar que o mesmo resultado ocorre em crianças. O objetivo desta revisão sistemática e meta-análise foi avaliar a eficácia do BPEE em cirurgias cardíacas pediátricas.
Métodos
Pesquisas sistemáticas no Medline, Embase e Cochrane foram conduzidas para estudos que compararam BPEE versus nenhum bloqueio ou bloqueio simulado para cirurgia cardíaca pediátrica sob esternotomia. O desfecho primário foi o consumo cumulativo de opioides por até 48 horas. As análises estatísticas foram realizadas com o uso do RStudio versão 1.2.1335. A heterogeneidade foi avaliada pelo teste Q de Cochran e estatísticas I2. A avaliação da qualidade e a avaliação do risco de viés obedeceram às recomendações da Cochrane.
Resultados
Cinco estudos envolvendo 328 pacientes (3 ensaios clínicos randomizados [ECR] e 2 coortes) foram incluídos. Dos 328 pacientes, 160 (48,7%) foram submetidos ao BPEE. Houve reduções significativas no consumo cumulativo de opioides até 48 horas após o BPEE (SMD -0,68; IC 95% -1,13 – -0,23; p < 0,01). Nos seguintes resultados, o BPEE não conseguiu mostrar superioridade: náusea e vômito pós-operatórios (OR = 0,56; IC de 95% 0,25–1,23; p = 0,54), febre (OR = 0,75; IC de 95% 0,24–2,31; p = 0,58), tempo de permanência na unidade de terapia intensiva em horas (MD -2,42; IC de 95% -5,47–0,64; p < 0,01] e tempo de permanência hospitalar em dias (MD -0,87; IC de 95% -2,69–0,96; p = 0,02). Apenas um estudo de coorte teve alto risco de viés.
Conclusão
O BPEE reduz potencialmente a dor pós-operatória por reduções significativas no consumo cumulativo de opioides até 48 horas em pacientes pediátricos de cirurgia cardíaca.
Palavras-chave
References
1. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg. 2019;154:755 −66.
2. Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D. Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg. 2020;131:127−35.
3. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block. Reg Anesth Pain Med. 2016;41:621−7.
4. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN). Anesth Analg. 2012;115:1353−64.
5. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
6. Vilanova ID, Almeida SB, De Araujo VS, et al. Impact of orthog- nathic surgery on voice and speech: a systematic review and meta-analysis. Eur J Orthod. 2023;45:747−63.
7. Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis [Internet]. [cited 2024 Mar 28]. Available from: https://synthesismanual.jbi.global.
8. Moola S, Munn Z, Tufanaru C, et al. Systematic reviews of etiology and risk (2020). In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, eds. JBI Manual for Evidence Synthesis, JBI; 2024. Available from https://synthesismanual.jbi.global.
9. Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
10. Guyatt GH, Oxman AD, Vist GE, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924−6.
11. Karacaer F, Biricik E, Ilg{nel M, Tunay D, Topcuo ¸ glu S,¸ Unl € ugen € c¸ H. Bilateral erector spinae plane blocks in children undergoing cardiac surgery: A randomized, controlled study. J Clin Anesth. 2022;80:110797.
12. Macaire P, Ho N, Nguyen V, et al. Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2020;45:805−12.
13. Kaushal B, Chauhan S, Magoon R, et al. Efficacy of Bilateral Erector Spinae Plane Block in Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy. J Cardiothorac Vasc Anesth. 2020;34:981−6.
14. Gado AA, Alsadek WM, Ali H, Ismail AA. Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via Sternotomy: A Randomized Controlled Trial. Anesth Pain Med. 2022;12: e123723.
15. Roy N, Brown ML, Parra MF, et al. Bilateral Erector Spinae Blocks Decrease Perioperative Opioid Use After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth. 2021;35:2082−7.
16. Cruz-Suarez GA, Rebell on S anchez DE, Torres-Salazar D, et al. Postoperative Outcomes of Analgesic Management with Erector Spine Plane Block at T5 Level in Pediatric Patients Undergoing Cardiac Surgery with Sternotomy: A Cohort Study. Local Reg Anesth. 2023;16:1−9.
17. King M, Stambulic T, Servito M, Mizubuti GB, Payne D, El-Diasty M. Erector spinae plane block as perioperative analgesia for midline sternotomy in cardiac surgery: A systematic review and meta-analysis. J Card Surg. 2022;37:5220−9.
18. Womersley JS, Nothling J, Toikumo S, et al. Childhood trauma, the stress response and metabolic syndrome: A focus on DNA methylation. Euro J Neurosci. 2022;55:2253−96.
Submitted date:
07/09/2024
Accepted date:
11/21/2024
