Analgesic Efficacy of Erector Spinae Plane Block in Pediatric Abdominal Surgery: Guidance with Conventional Method and NOL: Case Series

Abstract

Background: Erector spinae plane (ESP) block is a regional anesthesia technique that blocks both somatic and visceral nerve fibers.  Despite its high analgesic potential, its mechanism of action is not yet fully understood. The ultrasound-guided ESP block, which can be  easily performed, makes important contributions to the control of intraoperative pain in pediatric patients undergoing abdominal  surgery. The follow-up of pain in the intraoperative period is usually done by evaluating the changes in hemodynamic parameters. Due to  physiological differences in pediatric patients, it is more difficult to do this with only hemodynamic changes than in adult patients.  

Aim: The NOL® (Nociception Level) monitor calculates the nociception/pain score by evaluating many parameters through a proprietary  algorithm. Our primary aim was to demonstrate the effectiveness of ESP block with an advanced pain monitor in this patient group; our  secondary aim was to investigate the necessity of pain monitors in the pediatric patient group.

Methods: In this case series, we applied  intraoperative NOL® monitoring in addition to standard monitoring (ECG, SpO₂, heart rate, EtCO₂ ) in pediatric patients (16 cases) who  were scheduled for abdominal surgery and underwent ESP block.

Results: Considering the hemodynamic data, NOL values,  postoperative pain scores, side effects, and complications, it was concluded that ESP block can be used safely in this patient group. Although the hemodynamic data and the NOL® index were compatible with each other after a nociceptive stimulus, the NOL index was  less affected by other variables and gave the clinician clearer information about pain.