• Shruti Somani, Neeti Makhija, Sandeep Chauhan, Debesh Bhoi, Sambhunath Das, Sushama Gayatri Bandi, Palleti Rajashekar, and Akshya Kumar Bisoi.
• Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 1; 38 (4): 974981974-981.

ObjectiveThe aim of this study was to evaluate the efficacy of ultrasound-guided multiple injection costotransverse block (MICB) and compare it with erector spinae plane block (ESPB) for poststernotomy pain relief in pediatric cardiac surgical patients.DesignA prospective, randomized, double-blind, comparative study.SettingAt a single institution tertiary referral cardiac center.ParticipantsA total of 90 children with acyanotic congenital heart disease requiring surgery via sternotomy.InterventionsChildren were allocated randomly to 1 of the 3 following groups: ESPB (group 1), MICB (group 2), or Control (group 3). Participants in groups 1 and 2 received 4 mg/kg of 0.2% ropivacaine for bilateral ultrasound-guided block after induction of anesthesia. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl/tramadol was used for rescue analgesia.Measurements And Main ResultsThe modified objective pain score (MOPS) was evaluated at 0, 1, 2, 4, 6, 8, 10, and 12 hours postextubation. After all exclusions, 84 patients were analyzed. The MOPS score was found to be significantly lower in ESPB and MICB groups compared to the control group until 10 hours postextubation (p < 0.05), with no statistically significant difference at the 12th hour (p = 0.2198). The total intraoperative fentanyl consumption (p = 0.0005), need for fentanyl supplementation on incision (p < 0.0001), and need for rescue opioid requirement in the postoperative period (p = 0.034) were significantly lower in both the ESPB and MICB groups than the control group. There were no statistically significant differences in both primary and secondary outcomes between the ESPB and MICB groups.ConclusionUltrasound-guided MICB was effective and comparable to ESPB for post-sternotomy pain management in pediatric cardiac surgical patients.Copyright © 2023 Elsevier Inc. All rights reserved.

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