Master course of Regional Anesthesia:
Erector Spinae Plane (ESP) block in cardiac & thoracic surgeries to provide a safe and efficient analgesia opioid free

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Overview

Over the years we have been facing Challenges to provide an pain free opioid free in open heart surgeries and other thoracic surgeries. For Open heart surgeries still present moderate to severe acute post operative pain and researchs have shown that current analgesia have shown good efficacy for postoperative pain at rest, without reaching the full pain relief.

From May 2017 until now, Vinmec The anesthesia teams of VinMec International Hospitals central park and Times City decided to applied a technique as Erector Spinae Plane (ESP) block in cardiac & thoracic surgeries and we got this significant result:

During this period the data collected in open heart surgeries showed no complication or major incident. One incident: a catheter placed in Intra-vascular providing inefficient analgesia. Since an additive safety test was created to prevent such mis-location.

The success rate of bilateral efficient analgesia opioid free is 96,8%.

We also be the first presented first world cases during World Congress of regional anaesthesia and pain medicine in New York City April 2018.

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With the aim to to provide a safe and efficient analgesia opioid free, we organize this course to present the comprehensive training on ESP block

What is ESP and why ESP?

The pain after open cardiac surgery
In 2017 Open heart surgeries still present moderate to severe acute post operative pain [1,2]. The pain may originate from the surgical incision, the sternotomy, the mediastinal drains and the thoracic spine (costo transverse and costo vertebral joints). A painful postoperative period after cardiac surgery may promote patho physiologic transformation in major organs which could lead to extensive postoperative morbidity [3]. Breakthrough pain during movement and physiotherapy is important after open cardiac surgery limiting the daily activity programs of the patients and rehabilitation.

The current multimodal analgesia associating paracetamol, nefopam, NSAIDs and opioids is not optimal. It may have shown good efficacy for postoperative pain at rest, without reaching the full pain relief.

The use of opioids generated well-known side effects as delay in recovery time and hospital stay [4], nausea-vomiting, pruritus, respiratory depression, dependency and induced hyperalgesia syndrome and pain chronicisation after surgery [5].

The risk of chronic pain is increased when patients present high acute pain episods after surgery during three or four days[6]. After cardiac surgery the prevalence to develop a chronic pain is between 27 to 48% with moderate to severe pain more than one year after the surgery [7].

The evidences concerning the use of regional anesthesia analgesia techniques for post-op pain relief:

  • The impact of epidural and paravertebral blockade, spinal analgesia, nerve blocks, and new regional anaesthesia techniques on main procedure-specific postoperative outcomes is very important in opioids decreased use in the context of fast-track programs that are fully suggested after cardiac surgery.[8]
  • Andrea et al showed in a Cochrane group meta-analysis that regional anesthesia techniques are able to prevent chronic pain after surgery compared to opioids or multimodal analgesia techniques [9].
  • Many studies show that a complete pain relief after surgery improves the surgical outcome and the quality of life of the patients

The techniques of regional anesthesia available for open heart surgeries:

  • A continuous LA IV infusion after cardiac surgery can reduce pain score at 72 hours, shorten time to ambulation, and reduce morphine consumption at 48 hour.
  • Thoracic epidural analgesia and intrathecal morphine administration that can effectively treat pain, but have several concern related to their potential complications due to the peri-operative anticoagulation and the unacceptable risk of epidural hematoma [10].
  • The bilateral continuous paravertebral block that has equivalent analgesic effects to epidural analgesia but It is an advanced technique of regional anesthesia and not all anesthesiologists are skilled to perform such advanced technique.
  • Bilateral Parasternal multihole catheter inserted by the surgeon was described and published but it provides only the anterior pain relief
  • The serratus plane block may block only external part of the sternal and the drain pain. It will not block the thoracic back pain

–> The ESP Block recently described is an inter-fascial block described as a safe quite simple technique, far from risky anatomical structures. Already a Prospective study on 59 adults for open heart surgeries was presented at the world congress of ASRA as oral communication and a case reported by the team of Stanford University. It was used also as rescue analgesia for thoracic surgery. It has been published also in thoracic paediatric surgeries.

 

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Why should it be our course:
  • The very first course available internationally providing training for the latest opioid free analgesia technique in thoracic surgeries
  • Intensive Course combining lectures, workshops hands on model, live demonstration and simulation on phantom
  • Organizing and training by ESP “creator” and pioneers in applying ESP in open heart surgeries: Nga Ho MD and Prof. Dr. Philippe Macaire
  • The course is conducted English with Vietnamese translation
What will you learn:
  • The course will be organized within 1 day following this program:
    8.00 Welcome
  • 8.30 – 10.30 LECTURES
    8.30 – 8.50 : Anatomy for ESP
    8.50 – 9.10 : The block performance
    9.10 – 9.30 ; The outcomes in cardiac surgery
    9.30 – 9.50 : The infusion of LA and follow up
    9.50 – 10.10 ; The settings
    10.10 – 10.30 : Discussion
  • 10.30 – 10-45 ; Coffee break
  • 10.45 – 12-00 WORKSHOP HANDS ON
    Station 1 ; Ultrasound scans on model
    Station 2 : How to set up Intermittent automatic boluses
  • 12.00 – 13-00 ; Coffee break
  • 13.00 – Live case Demo from the OT by webcam
  • 14.00 – Video cases
  • 15.00 – 15.15 Coffee break
  • 15.15 – 17.00 WORKSHOP HANDS ON
    Station 1 ; Ultrasound scans on model
    Station 2 : Phantom probe needle coordination
  • 17.00 – Certificates
What will you achieve

Upon completing this course, you will be able to:

The course will deliver the complete knowledge about ESP

Know the requirements to perform regional anaesthesia analgesia in Thoracic surgeries.

  • Know the neuro and sono anatomy required to perform ESP blocks
  • Know the safety processes
  • Know how to manage analgesia by Interfascial catheters
  • Know the process and tips for the ultrasonographic scan for ESP blocks.
  • Know the infusion regimen of local anaesthetics for ESP blocks

 

Accreditation for the course will be CME credits by Vinmec

We also offer full package of:

Booklet or e-Book with:

  • The check list for open heart surgeries with ESP catheters
  • The setting list
  • The Bibliography
  • The training plan
  • The catalogue of the devices
  • The speaker slides in PDF
  • The infusion regimen for
    • Adults
    • Infants
Who we are
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Philippe MACAIRE, (M.D.), Ph.D

Director of Anesthesiology and Pain Management of VinMec Healthcare Management

Professor at Vinmec Medical University Project (Hanoi, Vietnam)

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Nga Ho M.D

Dr. Nga is currently Anesthesiologist Cardiac Surgeon

Department Vinmec International Hospital – Central Park

Philippe MACAIRE, (M.D.), Ph.D

More than 20 years of Experience in anesthesiology and pain management with international exposure, he has been working across countries France, United Kingdom, Dubai UAE, Thailand and Vietnam.

He is heading the ESP block research and first person to apply this technique in Vietnam as well as all over the world.

Dr. Nga Ho MD

Nearly 20 years of experience in Cardiac Anesthesiology fot both aldult and infant. She actively participates in cardiac surgeon in several hospitals in Hochiminh City

Dr. Ho Thi Xuan Nga is the one who presentd ESP research in open heart surgery at the 43rd Anesthesia World Congress (New York, USA) in April, 2018.

Training and research exposure:
– Training on cardiac anesthesia at the University of Medicine and Pharmacy Ho Chi Minh, University of Victor Segalen Bordeaux 2 (France)
–  Training courses on anesthesia, emergency, transplant … with many international experts.

Application of ESP research in open heart surgery at Vinmec Central Park

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Dr. Ngoc Dao Nguyen Thi

Anesthesiologist Ho Chi Minh University of Medicine and Pharmacy Hospital

Lecturer of Anesthesia Department Ho Chi Minh University of Medicine and Pharmacy

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Dr. Minh Chinh Quach

Anesthesiologist in Vinmec International Hospital Times City

With nearly 15 years of Experience in Anesthesiology

Dr. Ngoc Dao Nguyen Thi

Training and education
– Currently a PhD student and Resident of Ho Chi Minh University of Medicine and Pharmacy Hospital
– Training course of Anesthesiology for Liver Transplant Surgery at ASAN Medical Center, Seoul, Korea

Dr. Minh Chinh Quach

Training and Education:
– Graduate from Hanoi Medical University and Residents of Anesthesiology at Hanoi Medical University from 2006-2009
– Participation in local and international training courses

Contact

Please email to:
v.maihn@vinmec.com
with subject [Name]_[Title]_[Airwaycourse] for registration.