ESRA19-0562 Bilateral continuous erector spinae planeblocks for the management of post-thoracosternotomy pain in patients undergoing lung transplantation – initial experience at toronto general hospital
Bibliographic record
Abstract
Background and aims The management of postoperative pain is a challenging and contentious issue in patients who undergo lung transplantation. Poorly managed acute pain may have a significant adverse impact on clinical outcomes. In particular, the impact on respiratory mechanics may lead to graft dysfunction and prolonged mechanical ventilation. Thoracic epidural analgesia (TEA), the gold standard, is frequently precluded. The erector spinae plane (ESP) block, a novel interfascial plane block, has been shown to provide efficacious analgesia in thoracic patients, whilst potentially avoiding the complications of TEA. Methods We conducted a retrospective review of 15 patients who had bilateral ESP blocks placed intraoperatively for the management of pain following lung transplantation. We reviewed opioid consumption and pain scores in the first 72 hours, time to extubation, functional outcomes, and any documented technical block issues. Results Fifteen patients underwent lung transplantation via bilateral thoracosternotomy. Thirteen required intraoperative VA-ECMO. There was a reduction in overall opioid use in the first 72 hours. Mean numerical pain scores were 4 at rest (range 2–6), and 6 with movement (range 2–10). The majority were extubated within the first 12–24 hours, commenced initial physiotherapy exercises on postoperative day (POD) 1, and were ambulatory on POD 2. Catheter dislodgement occurred in 3 patients. Patient satisfaction was excellent overall. Conclusions The ESP block is a useful addition to our armamentarium in the management of acute pain following lung transplantation. To the best of our knowledge, this is the first case series describing the ESP block in this group.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".