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.