Background 

Regional anesthesia allows for opioid sparing and enhanced recovery after many major surgeries. Erector spinae plane (ESP) blockade, with reduced bleeding risk and the option for continuous infusion, offers an opportunity to promote this principle in pediatric liver transplant patients. Our goal was to evaluate pain scores, opioid use, return of bowel function, and hospital length of stay following continuous ESP blockade in pediatric liver transplant recipients. 

Methods 

This retrospective cohort study included extubated patients who received a liver transplant at St. Louis Children’s Hospital from July 2016 to July 2021. The control group (n=18), who did not meet criteria for ESP blockade and received standard analgesia regimens, was compared to the group receiving continuous ESP blockade (n=22). Measured outcomes included demographics, pain scores, opioid consumption through postoperative day two, date of first bowel movement, and length of stay in the pediatric intensive care unit and the hospital. 

Results 

Patient demographics between control and ESP groups showed no significant differences. Pain scores between control and ESP groups also showed no significant differences. Intraoperative and postoperative opioid requirements, studied in oral morphine equivalents per kilogram (OME/kg), were significantly lower at each time point studied for patients with ESP blockade. Time to first bowel movement was significantly shorter for the ESP group (postoperative day 3 for the ESP group vs day 4 for the control group). No significant differences were found in the length of pediatric intensive care unit or hospital stay. There were no safety concerns or complications related to ESP blockade.

Conclusions 

Use of continuous ESP blockade resulted in reduced opioid consumption and earlier return of bowel function.