OPIOID-FREE ANESTHESIA FOR ESOPHAGOPLASTY IN NEWBORNS: NEW POSSIBILITIES OF ULTRASOUND-GUIDED ESP BLOCK

Abstract

At the current stage of pediatric anesthesiology development, the improvement of regional anesthesia/analgesia methods as a component of multimodal anesthesia for surgical interventions in newborns is considered highly relevant. Objective.To evaluate the effectiveness and clinical applicability of ultrasound-guided ESP block in newborns undergoing esophagoplasty. Materials and methods. The ESP block was applied as a component of general anesthesia in 32 newborns with esophageal atresia. A comparative analysis was performed to assess the effectiveness of regional anesthesia with ESP block versus opioid-based general anesthesia in terms of extubation duration, ventilation requirements, and analgesia levels in the postoperative period. Hemodynamic and respiratory monitoring was carried out in all groups. Results. Among 15 full-term newborns in the main group, only 2 (6.25%) required prolonged mechanical ventilation in the postoperative period, compared to 40.6% in the group with opioid-based general anesthesia. The need for mechanical ventilation in preterm newborns was observed in both groups and amounted to 15.6% and 3.12%, respectively. Full-term newborns in the main group (n=8; 25.0%) were extubated earlier compared to the control group (n=3; 9.37%), with a statistically significant difference (p<0.05). The average time to extubation for full-term newborns in the group with general anesthesia and ESP block was 1 hour and 20 minutes (±0.95), whereas in the opioid anesthesia group, this figure reached 3 hours and 40 minutes (±1.25) (P<0.001). In preterm newborns, extubation was performed at an average of 6 hours and 20 minutes (±2.75) in the ESP block group, compared to 12 hours and 80 minutes to 3 days in the opioid anesthesia group, which was also statistically significant (P<0.001). Conclusions. Ultrasound-guided ESP block as a component of multimodal anesthesia in newborns with esophageal atresia is a safe and technically simple method. It provides adequate pain management during and after surgery, facilitates early recovery, and reduces the need for prolonged mechanical ventilation.