{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:34:15Z","timestamp":1793255655567,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,16]],"date-time":"2022-10-16T00:00:00Z","timestamp":1665878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The erector spinae plane block (ESPB) is a multimodal opioid-sparing component, providing chest-wall analgesia of variable extent, duration, and intensity. The objective was to examine the ESPB effect on perioperative opioid usage and postoperative rehabilitation when used within a Nociception Level (NOL) index-directed anesthetic protocol. Materials and Methods: This prospective, randomized, controlled, open-label study was performed in adult patients undergoing on-pump cardiac surgery in a single tertiary hospital. Eighty-three adult patients who met eligibility criteria were randomly allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 40) and received general anesthesia with NOL index-directed fentanyl dosing. Preoperatively, group 2 also received bilateral single-shot ultrasound-guided ESPB (1.5 mg\/kg\/side 0.5% ropivacaine mixed with dexamethasone 8 mg\/20 mL). Postoperatively, both groups received intravenous paracetamol (1 g every 6 h). Morphine (0.03 mg\/kg) was administered for numeric rating scale (NRS) scores \u22654. Results: The median (IQR, 25th\u201375th percentiles) intraoperative fentanyl and 48 h morphine dose in group 2-to-group 1 were 1.2 (1.1\u20131.5) vs. 4.5 (3.8\u20135.5) \u00b5g\u00b7kg\u22121\u00b7h\u22121 (p &lt; 0.001) and 22.1 (0\u201340.4) vs. 60.6 (40\u201395.7) \u00b5g\/kg (p &lt; 0.001). The median (IQR) time to extubation in group 2-to-group 1 was 90 (60\u2013105) vs. 360 (285\u2013510) min (p &lt; 0.001). Two hours after ICU admission, 87.5% of ESPB patients were extubated compared to 0% of controls (p &lt; 0.001), and 87.5% were weaned off norepinephrine compared to 46.5% of controls (p &lt; 0.001). The median NRS scores at 0, 6, 12, 24, and 48 h after extubation were significantly decreased in group 2. There was no difference in opioid-related adverse events and length of stay. Conclusions: NOL index-directed ESPB reduced intraoperative fentanyl by 73.3% and 48 h morphine by 63.5%. It also hastened the extubation and liberation from vasopressor support and improved postoperative analgesia.<\/jats:p>","DOI":"10.3390\/medicina58101462","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T02:29:46Z","timestamp":1665973786000},"page":"1462","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery: A Randomized Controlled Clinical Trial"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-6390","authenticated-orcid":false,"given":"Cosmin","family":"Balan","sequence":"first","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"},{"name":"Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9673-5754","authenticated-orcid":false,"given":"Dana R.","family":"Tomescu","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"3rd Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7530-2781","authenticated-orcid":false,"given":"Liana","family":"Valeanu","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"},{"name":"Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Morosanu","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"},{"name":"Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3363-4168","authenticated-orcid":false,"given":"Iulia","family":"Stanculea","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Coman","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca","family":"Stoian","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serban I.","family":"Bubenek-Turconi","sequence":"additional","affiliation":[{"name":"Cardiac Anesthesiology and Intensive Care Department I, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania"},{"name":"Anesthesiology and Intensive Care Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/1089253210378401","article-title":"Pain Management after Cardiac Surgery","volume":"14","author":"Cogan","year":"2010","journal-title":"Semin. Cardiothorac. Vasc. Anesthesia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1053\/j.jvca.2020.09.103","article-title":"Reducing Opioid Use in Patients Undergoing Cardiac Surgery\u2014Preoperative, Intraoperative, and Critical Care Strategies","volume":"35","author":"Ochroch","year":"2021","journal-title":"J. Cardiothorac. Vasc. 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