Erector Spinae Plane (ESP) Block and Neuromonitoring for Cardiac Surgery
Take Home Message
ESP-Block: The risk of hematoma formation when performing this technique is unknown.
There is a lack of randomized controlled trials to justify its safety in this field.
Therefore, ESP-block is not recommended in anticoagulated patients.
ESP-Block: Postoperative analgesia provided by single-shot local anesthetics (bilateral)
does not appear to be effective. Alternatives such as catheter placement for continuous infusion
or repeating the ESP-block in the ICU 24 hours after the first injection may provide better analgesia.
It is necessary to understand the relationship between processed EEG with spectrogram and brain tissue oxygenation during cardiac anaesthesia so that diagnoses and interventions bring the best outcomes.
What’s in it for me?
After participating in this webinar, you will gain a better understanding of:
– The feasibility and efficacy of erector spinae plane blocks in cardiac surgery;
– The benefits and clinical applicability of neuromonitoring during cardiac surgery.
Programme
Time
Topic
Speaker
18:00 – 18:10
Presentation of the Centre
Caetano Nigro Neto MD, PhD
18:10 – 18:30
Case Report: ESP-block for CABG Surgery
Diego Araújo MD, TEA-SBA
18:30 – 18:40
Discussion 1: Monitoring
Eric Benedet Lineburger MSc, PhD, TSA, ASRA-PMUC, FASE
18:40 – 18:50
Discussion 2: ESP-block in Cardiac Surgery
Vinicius Nascimento MD, NBE-Testamour, TEA-SBA
18:50 – 19:30
Open Discussion
All Speakers
This seminar is organized in collaboration with the EACTAIC Education Committee and
supported by the Dante Pazzanese Institute of Cardiology – São Paulo, Brazil.
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Event Details
10
Days
50
Hours
10
Min
00
Sec
Start Date
March 07, 2022 6:00 pm
End Date
March 07, 2022 7:30 pm
Status
Expired
Meet the Speakers
Caetano Nigro Neto MD, PhD
Brazilian EACTAIC Representative
Programme Director – EACTAIC/CTVA – São Paulo (Brazil)
Head of Anesthesia Section, Dante Pazzanese Institute of Cardiology
Scientific Director – ANESTE-Z
International Committee – SCA
Diego Araújo MD, TEA-SBA
EACTAIC / CTVA Fellow
Dante Pazzanese Institute of Cardiology – São Paulo (Brazil)
Vinicius Nascimento MD, NBE-Testamour, TEA-SBA
Dante Pazzanese Institute of Cardiology – São Paulo (Brazil)
Instructor, Education Center ANESTEZ
Eric Benedet Lineburger MSc, PhD, TSA, ASRA-PMUC, FASE
Hospital São José – Criciúma (Brazil)
Instructor, Education Center ANESTEZ
We just use local anesthetics in our daily practice. Surgeons do like anything that could help postoperative analgesia for their patients. 2 steps we never considered. About modulate stress response there are still many doubts about it
Before, we did mostly a combine spinal anesthesia with morphine and fentanyl + general inhalation anesthesia. We didn’t changed all cases, but we are trying to see if this technique could be better than before in terms of post operative analgesia
Yes, he did. But mostly only during induction. When we make a block like ESP_BLOCK to help analgesia , we decrease a lot the need of opioids intraoperative
If you have catheter available and have the skills to insert and take care on postoperative period, it would be better in this case for sure
Just ESP
That’s a very good option when you have the opportunity to make it continuous
So far, no good trials to confirm this statement
I guess that any block, including spinal or peridural helps the discharge of patients faster from ICU, specially
Unfortunately, we do not measure in the ICU Officially, but we are preparing a protocol for that
So far, no complications, but we do respect guidelines for anticoagulation
Not really…in our experience in average 8 - 12 hours, but the consumption of analgesics in the first hours in ICU is reduced
DIPYRONE, MORPHINE (PCA)
esp block started in 2016 for patients with chronic pain, so it’s interesting for this area
Intravenous morphine, this is what we have available in our Institution….but I guess an Intravenous PCA with opioids would be better if you have available
(1) normally, the patient use de PCA for 3 days, sometimes 2 days after the surgery. The amount of morphine is 0,1 mg/Kg
(2) Unfortunately in our Institution we don’t have morphine PCA….only Morphine intravenous the patients consume approx.?
I am sorry, but we've never tried it yet
I am sorry but we really don’t have experience with Pectointercostofascial block to make precise comments
Unfortunately, we do not have many good RCTs so far to really assure that this technique is the best option to most of the patients.
Rib is round and tranverse process is flat. Tranverse process is medial than the rib.
I am sorry. We don't do other periferal block than ESP-Block, so we cannot make comments about this.
In our centre, in plane is the option always.
Unfortunately, we do not have experience with catheters in this technique.
This is a good question. Could be an option but in our Centre we don't consider this technique in these cases.
Intravenous Morphine, continuos or every 4 hors bolus doses.
In our centre we just consider making ESP-Block. There is a lack of studies to assure the one technique is better that other.
So far, no complications, but we do respect guidelines for anticoagulation
Sorry, not so far.
Mostly of the evidence is about to avoid postoperative delirium. I mean, outcomes evidence.
Especially when the BIS value is less than 30, the SR is inversely proportional to the decrease in BIS value
No, as I said, a multimodal approach with ETAC and neurovegetative signs should be ideal to avoid recall. With TIVA there’s more evidence
The sudden appearance of asymmetry (> 20%) in the BIS is a strong sign of cerebral hypoperfusion (and the higher than 20%, the greater the probability) and therefore during CPB, increasing the MAP would be an initial attitude consistent with this sign.
Exactly. I don’t use BZD at all in older CDV patients. This could increase postoperative delirium.
I would watch NIRS for sure because BIS during this sistuation is frequently zero with a 100% supression rate.
5 mcg/Kg/h dex: continuous infusion 0 5 mcg/Kg/h after a prime of 0 5 mcg/kg in 20 minutes
The full recording will be available soon for EACTAIC members on the eAcademy
Opening, Mohamed El Tahan, Caetano Nigro Neto, March 8, 2022
