Results
Twenty-four patients were enrolled in the study. Eleven patients
received only wound infiltration and 13 patients received left ESP
block. No patients who were approached declined participation in the
study, nor were any excluded or lost to follow-up. Mean (SD) ages are 56
(11) and 57 (13) for the would infiltration and ESP block, respectively.
The percentage of male subjects were 72.7% and 84.6% in the wound
infiltration and ESP block, respectively. There were no significant
differences between the two groups in age, sex, BMI, ASA score, ejection
fraction and comorbidities including being on anti-coagulation, a-fib,
COPD, smoker, HTN, DM, CAD, pulmonary HTN, ESRD, CAD, OSA (Table 1).
A small but significant reduction of intraoperative fentanyl use was
observed (p= 0.001) with a median of 75 [50, 100] mcg and 0 [0,
50] mcg in the wound filtration and ESP block group, respectively
(Table 2). The overall postoperative day (POD) zero fentanyl use was
also significantly decreased (p=0.049; median [IQR] of 100 [87.5,
150] mcg and 75 [50, 100] mcg of fentanyl used in the no block and
block group, respectively. There was a trend of decreased POD zero
oxycodone-acetaminophen (5-325mg) use, a median of 1 tab vs 0 tab,
although it did not reach statistical significance (p=0.149). The day to
discharge was shorter in the ESP block group (p=0.038), a median
[IQR] of 1 [1, 1] day, instead of 1 [1, 2] day without the
block. No NSAIDs were given due to risk of bleeding per
electrophysiology team request. Other pain medication uses were not
different between the two group on POD0 or POD1 and those pain
medications include acetaminophen, ketamine, hydromorphone, morphine,
and tramadol.
No difference was noted in vital sign changes following incision, total
procedural time, total anesthesia time, or highest pain scores including
immediately postop, on POD zero and POD one (Table 2). The median
surgical time was 83 [73, 93.5] minutes for the wound infiltration
group and 79 [73, 89] minutes in ESP block group. The median pain
scores were both 0 [0, 1.5] upon arrival to PACU in the no block
group and 0 [0, 0] in the ESP block group, and 5 on POD zero and POD
one for both groups. The median propofol use were 66.5 [ 47.3, 73.7]
mg in the wound infiltration group and 76.1 [53.0, 101] mg in ESP
group, which was not statistically significant (p= 0.213). Similarly,
there was no difference in the amount of midazolam administered. Length
of stay in the intensive care unit also was not different between the
two groups (p = 0.116). There was no need to induce GA in any patients.
No complications, including local anesthetic toxicity, hematoma,
intrathecal injection, pneumothorax or prolonged paresthesia were
observed.