A Comparison between Ultrasound Guided Erector Spinae Block Using Bupivacaine Versus Parasternal Nerve Block in Pediatric Patients Undergoing Cardiac Surgery for Post-Operative Pain Management after Median Sternotomy: A Randomized Controlled Double-Blinded Study

Abstract Background: Children of all ages experience pain. An explosion in pain research over the last decade has elucidated more clearly our understanding of pain mechanisms, appro-priate pain assessment, and the safe applicaton of innovatve pharmacologic and non-pharmacologic strategies to treat pain in adults and children. In additon, we now understand that the negatve consequences of untreated pain may have profound efects on physiologic homeostasis, and in the case of the post-operatve patent, morbidity and mortality may be adversely afected, especially in the pediatric populaton undergoing major surgeries such as cardiothoracic surgeries. Aim of Study: The aim of this study was to compare the efficacy of Parasternal nerve vs Erector Spinae Plane Block in comparison with the control group. Patients and Methods: The study was conducted between June 2022 and January 2023 and was carried at the Cardiot-horacic Surgery Department operation theater. Patients sched-uled for elective cardiac surgery for non cyanotic ASD & VSD repair were recruited in this randomized research. 3 Groups were assigned in this research: •Group A: Received Erector spinea plane ESP block, a total 20mL of 0.25% bupivacaine was given. •Group B: Received Parasternal plane PSI block, a total 20mL of 0.25% bupivacaine was given. •Group C: Was the control group which was managed with intraoperatve fentanyl for analgesia and Morphine for postoperatve pain control. - FLACC score was recorded in each group every 4 hours postoperative after extubation at 4,8,12 hrs respectively and at a maximum of 24 hrs post operative and if score was =>3, analgesia was given ( Morphine 0.05-0. 1 mg/kg). - Total Postoperative 12 hours morphine consumption was recorded in each group and compared with the control group. Results: 72 patients in total participated in this study, there were no statistical significant differences between the study groups regarding demographic and operation character-istics; age, gender, weight, operation duration and intervention. Patients in group A, showed lower FLACC scores and the need for rescue analgesia was lower than that of group B and group C. Conclusion: Our study has shown that, Erector Spinae block using Bupivacaine (0.25%) was superior in efficacy and duration to Parasternal nerve block using bupivacaine (0.25%), and both were superior to the control group for controlling peri-operative pain in pediatric patients undergoing cardiac surgery.