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Subramaniam K, Sciortino CM, Boisen ML, La Colla L, Dickson A, Nowakowski E, Prangley K, Ruppert KM. Sternotomy Wound Infiltration With Liposomal Versus Plain Bupivacaine for Postoperative Analgesia After Elective Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:42-49. [PMID: 36347730 DOI: 10.1053/j.jvca.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Poor pain control after cardiac surgery can be associated with postoperative complications, longer recovery, and development of chronic pain. The authors hypothesized that adding liposomal bupivacaine (LB) to plain bupivacaine (PB) will provide better and long-lasting analgesia when used for wound infiltration in median sternotomy. STUDY DESIGN Prospective, randomized, and double-blinded clinical trial. SETTING Single institution, tertiary care university hospital. PARTICIPANTS Adult patients who underwent elective cardiac surgery through median sternotomy. INTERVENTIONS A single surgeon performed wound infiltration of LB plus PB or PB into the sternotomy wound, chest, and mediastinal tube sites. MEASUREMENTS AND MAIN RESULTS Patients were followed up for 72 hours for pain scores, opioid consumption, and adverse events. Sixty patients completed the study for analysis (LB group [n = 29], PB group [n = 31]). Patient characteristics, procedural variables, and pain scores measured at specific intervals from 4 hours until 72 hours postoperatively did not reveal any significant differences between the groups. Mixed-model regression showed that the trend of mean pain scores at movement in the LB group was significantly (p = 0.01) lower compared with the PB group. Opioid consumption over 72 hours was not significantly different between the 2 groups (oral morphine equivalents; median [interquartile range], 139 [73, 212] mg in LB v 105 [54, 188] mg in PB, p = 0.29). Recovery characteristics and adverse events were comparable. CONCLUSIONS LB added to PB for sternotomy wound infiltration during elective cardiac surgery did not significantly improve the quality of postoperative analgesia.
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Affiliation(s)
- Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
| | | | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Alec Dickson
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Emma Nowakowski
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Kelly Prangley
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Kristine M Ruppert
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh, Pittsburgh PA
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The effects of eye masks on post-operative sleep quality and pain in school-age children with CHD. Cardiol Young 2022; 32:1575-1579. [PMID: 34776029 DOI: 10.1017/s1047951121004480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to explore the effects of eye masks on the sleep quality and pain of school-age children with CHD after surgery. METHODS Forty school-age children with CHD who underwent open-heart surgery in the Cardiac Surgery Department of a provincial hospital in China from January 2020 to December 2020 were selected. The children were randomly divided into the experimental group (n = 20) and the control group (n = 20). Children in the control group were given routine sleep care, and the children in the experimental group were given a sleep intervention with eye masks for three nights following the removal of tracheal intubation. The Pittsburgh Sleep Quality Index was used to evaluate the sleep quality of the children. The Children's Pain Behaviour Scale was used to evaluate the pain of the children. RESULTS After three nights of receiving the eye masks intervention, the sleep quality scores of the children in the experimental group were significantly lower than those of the control group, the difference was statistically significant (p < 0.05) and the sleep quality of the children in the experimental group was higher. The pain scores of the children in the experimental group were significantly lower than those of the children in the control group, the difference was statistically significant (p < 0.05), and the children in the experimental group suffered less post-operative pain. CONCLUSION Eye masks are a simple, safe and economical intervention, that is beneficial for improving the post-operative sleep quality and relieving post-operative pain in school-age children with congenital heart disease.
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Sadeq F, DePamphilis MA, Dabek RJ, Bojovic B, Fuzaylov G, Driscoll DN. Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis. Burns 2022; 48:1166-1171. [PMID: 34862091 DOI: 10.1016/j.burns.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures. METHODS This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed. RESULTS In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant. CONCLUSION In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
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Affiliation(s)
- Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Matthew A DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
| | - Robert J Dabek
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States
| | - Branko Bojovic
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Gennadiy Fuzaylov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel N Driscoll
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States.
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Murphy T, Sale SM, Gonzalez Barlatay F, Armstrong C, Parry A, Houghton E, Jerrom T, Schadenberg A. Initial results from an enhanced recovery program for pediatric cardiac surgical patients. Paediatr Anaesth 2022; 32:647-653. [PMID: 35156262 DOI: 10.1111/pan.14418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over recent years, a number of enhanced recovery programs have appeared in first, adult colorectal surgery, and subsequently many other adult surgical specialties. Increasing interest in this approach to perioperative management in children culminated in the recent development of the first enhanced recovery pathway for pediatric intestinal surgery, endorsed by Enhanced Recovery after Surgery Society (ERAS®). In parallel, there has been increasing interest in the refinement of perioperative management of selected pediatric cardiac surgical patients, invariably referred to as "fast track" management. Initiatives have largely focused on duration of postoperative ventilation rather than on a much wider range of perioperative interventions to optimize recovery and ensure timely discharge after surgery. In our institution, a "Level 1" pediatric cardiac surgical center, we assembled a multidisciplinary team to design a comprehensive enhanced recovery pathway, based on ERAS® methodology, for selected cardiac surgical patients. After a lengthy period of planning, staff education, and preparation, we implemented the pathway at the end of November 2019. METHODS We conducted a prospective audit of the perioperative management and outcomes of the first 88 patients managed according to this enhanced recovery pathway over a 25-month period in our institution. RESULTS The mean age of the patients was 5.8 years (range 0.5-17.9), and the mean weight was 22.4 kg (range 6.6-57.2). Sixty-eight of the 88 patients were cardiopulmonary bypass cases. A total of 54% of patients received all four defined intraoperative anesthetic interventions (intravenous paracetamol, non-steroidal anti-inflammatory drug, antiemetic if aged more than 4 years, and use of a local anesthetic technique). A total of 89% of patients met the target extubation time of 6 h after administration of protamine. Median postoperative intensive care unit length of stay was 23.5 h (range 15.2-89.5). When compared to a historic control group, this represented a 22% reduction in median intensive care unit stay, although the total hospital length of stay remained unchanged. A total of 83% of patients met the target hospital discharge target of the fifth postoperative day. CONCLUSIONS These preliminary results suggest that enhanced recovery pathway implementation for selected pediatric cardiac surgical patients is feasible, with acceptable outcomes. They suggest areas for further development and the potential for wider implementation.
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Affiliation(s)
- Tim Murphy
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - Steven M Sale
- Pediatric Cardiac Anesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | | | | | - Andrew Parry
- Congenital Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
| | | | - Tom Jerrom
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - Alvin Schadenberg
- Pediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
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Brodt JL, Tsui BCH. Benefits, Risks, and Challenges of Incisional Analgesia in Pediatric Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2021; 35:1722-1724. [PMID: 33836960 DOI: 10.1053/j.jvca.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jessica L Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Cardiac Anesthesia, Stanford University, Stanford, CA
| | - Ban C H Tsui
- Department of Anesthesiology, Perioperative and Pain Medicine, Divisions of Pediatric and Regional Anesthesia, Stanford University, Stanford, CA
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