Observing the effect of bilateral erector spinae plane block (ESPB) on the intraoperative opioid dosage in patients undergoing off-pump coronary artery bypass grafting (CABG) with midline thoracotomy.

From January to November 2023, 38 adult patients with coronary atherosclerotic heart disease were selected from the Cardiac Surgery Department of Jining No.1 People′s Hospital. They underwent a median sternotomy and off-pump CABG. The computer random number generator was used to divide them into 2 groups: the ESPB group and the control group. Before anesthesia induction, 20 ml of 0.375% ropivacaine was injected under ultrasound guidance between the T₅ transverse process and the erector spinae muscle in the ESPB group, and the same blockade was performed on the opposite side. The same dose of physiological saline was given in the control group for bilateral block. The dosage of sufentanil used during surgery, events related to opioids (mechanical ventilation time, cardiac intensive care unit time, hospital stay, postoperative nausea and vomiting), and adverse reactions related to nerve block (pneumothorax, local anesthetic toxicity, infection at the puncture site) were recorded.

One patient was excluded from the control group since the emergency extracorporeal circulation during surgery. Finally, 19 patients were included in the ESPB group, while 18 patients were included in the control group. The dosage of sufentanil during surgery was 150.0(120, 160)μg in the ESPB group, while in the control group was 200.0(166.3, 221.3)μg. There was a statistical difference (Z=-2.88, P=0.004) between the 2 groups. The average mechanical ventilation time in the ESPB group was 438.5(354.3, 521.5)min, while in the control group was 486.5(447.5, 664.5)min. There was a statistical difference between the 2 groups (Z=-2.34, P=0.019). There were no significant differences in the length of stay in the cardiac intensive care unit [65.4(45.4, 86.5)min, 68.2 (49.9, 88.5)min] and the length of hospital stay [13.5(11.0, 15.3)d, 12.5 (10.0, 15.0)d] between the 2 groups (Z=-0.46, 1.09, P>0.05). There were 2 patients in each group who experienced postoperative nausea and vomiting, and the difference was not statistically significant (P>0.05). None of the patients in either group developed complications associated with nerve blocks.

Preoperative ESPB significantly reduce the intraoperative opioid dosage in patients undergoing off-pump CABG, shorten mechanical ventilation time, and do not increase side effects. ESPB is a safe and effective anesthesia management technique for CABG.