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Yang G, Wang P, Yin Y, Qu H, Zhao X, Jin X, Chu Q. Erector spinae plane block versus paravertebral block on postoperative quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy: a randomized controlled trial. PeerJ 2024; 12:e17431. [PMID: 38827293 PMCID: PMC11141559 DOI: 10.7717/peerj.17431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112-140) vs. 124 (111-142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.
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Affiliation(s)
- Guanyu Yang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Pengfei Wang
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Yue Yin
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Huan Qu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Zhao
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaogao Jin
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
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Liao D, Peng K, Zhang Y, Liu H, Xia Z, Guo J, Wei F, Chen C, Lv X, Tong J, Li X, Qu X, Wang X, Wang Y, Ou S, Liu H, Shan X, Ji F. Effect of liposomal bupivacaine for preoperative erector spinae plane block on postoperative pain following video-assisted thoracoscopic lung surgery: a protocol for a multicenter, randomized, double-blind, clinical trial. Front Med (Lausanne) 2024; 11:1359878. [PMID: 38681056 PMCID: PMC11045961 DOI: 10.3389/fmed.2024.1359878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Background There is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery. Methods This multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis. Discussion We hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.
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Affiliation(s)
- Dawei Liao
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
- Department of Anesthesiology, Tongren People's Hospital, Tongren, China
| | - Ke Peng
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
| | - Yang Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
| | - Huayue Liu
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Guo
- Department of Anesthesiology, The Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Fujiang Wei
- Department of Anesthesiology, Yantaishan Hospital, Yantai, China
| | - Chen Chen
- Department of Anesthesiology, The First People’s Hospital of Changzhou, Changzhou, China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai, China
| | - Jianhua Tong
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoshuang Li
- Department of Anesthesiology, Lianshui County People's Hospital, Huaian, China
| | - Xianfeng Qu
- Department of Anesthesiology, Taizhou Municipal Hospital, Taizhou, China
| | - Xiaobin Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yingbin Wang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shanshan Ou
- Department of Anesthesiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, United States
| | - Xisheng Shan
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
| | - Fuhai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Anesthesiology, Soochow University, Suzhou, China
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Oostvogels L, Weibel S, Meißner M, Kranke P, Meyer-Frießem CH, Pogatzki-Zahn E, Schnabel A. Erector spinae plane block for postoperative pain. Cochrane Database Syst Rev 2024; 2:CD013763. [PMID: 38345071 PMCID: PMC10860379 DOI: 10.1002/14651858.cd013763.pub3] [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] [Indexed: 02/15/2024]
Abstract
BACKGROUND Acute and chronic postoperative pain are important healthcare problems, which can be treated with a combination of opioids and regional anaesthesia. The erector spinae plane block (ESPB) is a new regional anaesthesia technique, which might be able to reduce opioid consumption and related side effects. OBJECTIVES To compare the analgesic effects and side effect profile of ESPB against no block, placebo block or other regional anaesthetic techniques. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Web of Science on 4 January 2021 and updated the search on 3 January 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) investigating adults undergoing surgery with general anaesthesia were included. We included ESPB in comparison with no block, placebo blocks or other regional anaesthesia techniques irrespective of language, publication year, publication status or technique of regional anaesthesia used (ultrasound, landmarks or peripheral nerve stimulator). Quasi-RCTs, cluster-RCTs, cross-over trials and studies investigating co-interventions in either arm were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all trials for inclusion and exclusion criteria, and risk of bias (RoB), and extracted data. We assessed risk of bias using the Cochrane RoB 2 tool, and we used GRADE to rate the certainty of evidence for the primary outcomes. The primary outcomes were postoperative pain at rest at 24 hours and block-related adverse events. Secondary outcomes were postoperative pain at rest (2, 48 hours) and during activity (2, 24 and 48 hours after surgery), chronic pain after three and six months, as well as cumulative oral morphine requirements at 2, 24 and 48 hours after surgery and rates of opioid-related side effects. MAIN RESULTS We identified 69 RCTs in the first search and included these in the systematic review. We included 64 RCTs (3973 participants) in the meta-analysis. The outcome postoperative pain was reported in 38 out of 64 studies; block-related adverse events were reported in 40 out of 64 studies. We assessed RoB as low in 44 (56%), some concerns in 24 (31%) and high in 10 (13%) of the study results. Overall, 57 studies reported one or both primary outcomes. Only one study reported results on chronic pain after surgery. In the updated literature search on 3 January 2022 we found 37 new studies and categorised these as awaiting classification. ESPB compared to no block There is probably a slight but not clinically relevant reduction in pain intensity at rest 24 hours after surgery in patients treated with ESPB compared to no block (visual analogue scale (VAS), 0 to 10 points) (mean difference (MD) -0.77 points, 95% confidence interval (CI) -1.08 to -0.46; 17 trials, 958 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between the groups treated with ESPB and those receiving no block (no events in 18 trials reported, 1045 participants, low-certainty evidence). ESPB compared to placebo block ESPB probably has no effect on postoperative pain intensity at rest 24 hours after surgery compared to placebo block (MD -0.14 points, 95% CI -0.29 to 0.00; 8 trials, 499 participants; moderate-certainty evidence). There may be no difference in block-related adverse events between ESPB and placebo blocks (no events in 10 trials reported; 592 participants; low-certainty evidence). ESPB compared to other regional anaesthetic techniques Paravertebral block (PVB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PVB (MD 0.23 points, 95% CI -0.06 to 0.52; 7 trials, 478 participants; low-certainty evidence). There is probably no difference in block-related adverse events (risk ratio (RR) 0.27, 95% CI 0.08 to 0.95; 7 trials, 522 participants; moderate-certainty evidence). Transversus abdominis plane block (TAPB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to TAPB (MD -0.16 points, 95% CI -0.46 to 0.14; 3 trials, 160 participants; low-certainty evidence). There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.21 to 4.83; 4 trials, 202 participants; low-certainty evidence). Serratus anterior plane block (SAPB) The effect on postoperative pain could not be assessed because no studies reported this outcome. There may be no difference in block-related adverse events (RR 1.00, 95% CI 0.06 to 15.59; 2 trials, 110 participants; low-certainty evidence). Pectoralis plane block (PECSB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to PECSB (MD 0.24 points, 95% CI -0.11 to 0.58; 2 trials, 98 participants; low-certainty evidence). The effect on block-related adverse events could not be assessed. Quadratus lumborum block (QLB) Only one study reported on each of the primary outcomes. Intercostal nerve block (ICNB) ESPB may not have any additional effect on postoperative pain intensity at rest 24 hours after surgery compared to ICNB, but this is uncertain (MD -0.33 points, 95% CI -3.02 to 2.35; 2 trials, 131 participants; very low-certainty evidence). There may be no difference in block-related adverse events, but this is uncertain (RR 0.09, 95% CI 0.04 to 2.28; 3 trials, 181 participants; very low-certainty evidence). Epidural analgesia (EA) We are uncertain whether ESPB has an effect on postoperative pain intensity at rest 24 hours after surgery compared to EA (MD 1.20 points, 95% CI -2.52 to 4.93; 2 trials, 81 participants; very low-certainty evidence). A risk ratio for block-related adverse events was not estimable because only one study reported this outcome. AUTHORS' CONCLUSIONS ESPB in addition to standard care probably does not improve postoperative pain intensity 24 hours after surgery compared to no block. The number of block-related adverse events following ESPB was low. Further research is required to study the possibility of extending the duration of analgesia. We identified 37 new studies in the updated search and there are three ongoing studies, suggesting possible changes to the effect estimates and the certainty of the evidence in the future.
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Affiliation(s)
- Lisa Oostvogels
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Stephanie Weibel
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Meißner
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Peter Kranke
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management, BG-Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Alexander Schnabel
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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Hsieh M, Kim D, Peng D, Schisler T, Cook RC. Regional Anesthesia With Paravertebral Blockade Is Associated With Improved Outcomes in Patients Undergoing Minithoracotomy Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:357-364. [PMID: 37585808 PMCID: PMC10478324 DOI: 10.1177/15569845231190638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Severe postoperative pain has been shown to affect many patients following minimally invasive cardiac surgeries (MICS). Multimodal pain management with regional anesthesia, particularly by delivery of local anesthetics using a paravertebral catheter (PVC), has been shown to reduce pain in operations involving thoracotomy incisions. However, few studies have reported high-quality safety and efficacy outcomes of PVCs following MICS. METHODS Patients who underwent MICS at Vancouver General Hospital between 2016 and 2019 (N = 123) were reviewed for perioperative opioid-narcotic use. Primary outcomes were postoperative opioid use and hospital length of stay (LOS). Statistical analyses were performed using univariate and multivariable regression models to determine independent risk factors. RESULTS A total of 54 patients received routine systemic analgesia (control), 53 patients received a paravertebral catheter (PVC), and 16 patients received another mode of regional analgesia (non-PVC). The mean hospital LOS was significantly different in patients in the PVC group at 5.8 ± 2.0 days versus 8.3 ± 7.1 days in the control and 6.6 ± 2.3 days in the non-PVC group (P = 0.033). The percentage of patients who did not require postoperative oxycodone was significantly higher in the PVC group (48.1%), compared with the control (24.5%) and non-PVC (37.5%; P = 0.043) groups. CONCLUSIONS The administration of regional anesthesia using PVCs was associated with reduced need for opioids and a shorter LOS. The reduction in postoperative opioids may reduce the risk of potential opioid dependency in this population. Future studies should involve randomized controlled trials with systematic evaluation of pain scores to verify current study results.
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Affiliation(s)
- Monica Hsieh
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Diane Kim
- University of British Columbia, Vancouver, BC, Canada
| | - Defen Peng
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Richard C. Cook
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada
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Zhou K, Li D, Song G. Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis. Front Cardiovasc Med 2023; 10:1078756. [PMID: 37283577 PMCID: PMC10239891 DOI: 10.3389/fcvm.2023.1078756] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Methods Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. Results This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. Conclusions TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.
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Affiliation(s)
- Ke Zhou
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongyu Li
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Li S, Feng J, Fan K, Fan X, Cao S, Zhang G. The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Cardiothorac Surg 2023; 18:128. [PMID: 37041525 PMCID: PMC10091630 DOI: 10.1186/s13019-023-02210-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Intercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery. METHODS 126 patients, aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded. RESULTS VAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004). CONCLUSIONS For patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage. TRIAL REGISTRATION Chinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.
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Affiliation(s)
- Shuo Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Jinteng Feng
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Kun Fan
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Xiaoe Fan
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Shaoning Cao
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
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Wang L, Jiang L, Xin L, Jiang B, Chen Y, Feng Y. Effect of pecto-intercostal fascial block on extubation time in patients undergoing cardiac surgery: A randomized controlled trial. Front Surg 2023; 10:1128691. [PMID: 37021095 PMCID: PMC10067611 DOI: 10.3389/fsurg.2023.1128691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/23/2023] [Indexed: 04/07/2023] Open
Abstract
Objectives Epidural and paravertebral block reduce the extubation time in patients undergoing surgery under general anesthesia but are relatively contraindicated in heparinized patients due to the potential risk of hematoma. The Pecto-intercostal fascial block (PIFB) is an alternative in such patients. Methods This is a single-center randomized controlled trial. Patients scheduled for elective open cardiac surgery were randomized at a 1:1 ratio to receive PIFB (30 ml 0.3% ropivacaine plus 2.5 mg dexamethasone on each side) or saline (30 ml normal saline on each side) after induction of general anesthesia. The primary outcome was extubation time after surgery. Secondary outcomes included opioid consumption during surgery, postoperative pain scores, adverse events related to opioids, and length of stay in the hospital. Results A total of 50 patients (mean age: 61.8 years; 34 men) were randomized (25 in each group). The surgeries included sole coronary artery bypass grafting in 38 patients, sole valve surgery in three patients, and both procedures in the remaining nine patients. Cardiopulmonary bypass was used in 20 (40%) patients. The time to extubation was 9.4 ± 4.1 h in the PIFB group vs. 12.1 ± 4.6 h in the control group (p = 0.031). Opioid (sufentanil) consumption during surgery was 153.2 ± 48.3 and 199.4 ± 51.7 μg, respectively (p = 0.002). In comparison to the control group, the PIFB group had a lower pain score while coughing (1.45 ± 1.43 vs. 3.00 ± 1.71, p = 0.021) and a similar pain score at rest at 12 h after surgery. The two groups did not differ in the rate of adverse events. Conclusions PIFB decreased the time to extubation in patients undergoing cardiac surgery. Trial Registration This trial is registered at the Chinese Clinical Trial Registry (ChiCTR2100052743) on November 4, 2021.
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Affiliation(s)
- Lu Wang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Luyang Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Ling Xin
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Bailin Jiang
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yu Chen
- Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
- Correspondence: Yi Feng
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Zhong R, Zou Y, Bao S, Chen Y, Huang G, Wang L, Chen L, Zhong M, Liang W. Analgesic Efficacy of an Ultrasound-Guided Transversus Thoracis Plane Block Combined with an Intermediate Cervical Plexus Block on Postoperative Pain Relief After Trans-Areolar Endoscopic Thyroidectomy: A Single Center Prospective Randomized Controlled Study. J Pain Res 2023; 16:1059-1067. [PMID: 36998539 PMCID: PMC10045307 DOI: 10.2147/jpr.s402902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose This study aimed to investigate the analgesic effect of ultrasound-guided transversus thoracis plane block (TTPB) combined with intermediate cervical plexus block (ICPB) in the early postoperative period after trans-areolar endoscopic thyroidectomy. Patients and Methods A total of 62 female patients undergoing trans-areolar endoscopic thyroidectomy were randomly classified to the TTPB combined with ICPB group with ropivacaine (block group) or superficial cervical plexus block group (control group). The primary outcome measures were resting visual analogue scale (VAS) in the chest area at 6 h after surgery. The secondary outcome measures included chest resting and movement VAS score, neck resting and movement VAS score within 24 h after surgery, intraoperative remifentanil consumption, postoperative analgesia rate and analgesic requirements and patient satisfaction score for pain management at discharge. Results Compared with the control group, the block group at rest showed consistently lower VAS scores in the chest area at 6 and 12 h after operation; the block group at rest showed lower VAS scores in the neck at 6, 12 and 24 h after operation. Regarding movement, the VAS scores of the chest and neck area at 2, 6, 12 and 24 h after the operation were lower in the block group than in the control group. The consumption of remifentanil, rate of postoperative analgesic requirements, and consumption of postoperative rescue analgesia in the block group were lower than those in the control group. Satisfaction with pain treatment at discharge was higher in the block group than in the control group. Conclusion Ultrasound-guided TTPB combined with ICPB provides good analgesic effect in the early postoperative period after trans-areola endoscopic thyroidectomy.
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Affiliation(s)
- Ruipeng Zhong
- Gannan Medical University, Ganzhou, People’s Republic of China
- Department of Anesthesiology,Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
| | - Yun Zou
- Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - ShuZhen Bao
- Department of Anesthesiology,Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
| | - YiJian Chen
- Department of Anesthesiology,Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
| | - Guiming Huang
- Department of Anesthesiology,Ganzhou People’s Hospital, Ganzhou, People’s Republic of China
| | - Lifeng Wang
- Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Li Chen
- Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Maolin Zhong
- Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
| | - Weidong Liang
- Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, Ganzhou, People’s Republic of China
- Correspondence: Weidong Liang, Anesthesia Surgery Center, the First Affiliated Hospital of Gannan Medical University, No. 128, Jinling West Road, Economic and Technological Development Zone, Ganzhou, Jiangxi Province, 341000, People’s Republic of China, Tel +86 15970122157, Email
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Fessler J, Finet M, Fischler M, Le Guen M. New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010092. [PMID: 36676041 PMCID: PMC9865529 DOI: 10.3390/life13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/26/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
The management of lung transplant patients has continued to evolve in recent years. The year 2021 was marked by the publication of the International Consensus Recommendations for Anesthetic and Intensive Care Management of Lung Transplantation. There have been major changes in lung transplant programs over the last few years. This review will summarize the knowledge in anesthesia management of lung transplantation with the most recent data. It will highlight the following aspects which concern anesthesiologists more specifically: (1) impact of COVID-19, (2) future of transplantation for cystic fibrosis patients, (3) hemostasis management, (4) extracorporeal membrane oxygenation management, (5) early prediction of primary graft dysfunction, and (6) pain management.
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Affiliation(s)
- Julien Fessler
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
| | - Michaël Finet
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
| | - Marc Fischler
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
- Correspondence:
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
- University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
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10
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Shbeer A. Regional Anesthesia (2012-2021): A Comprehensive Examination Based on Bibliometric Analyses of Hotpots, Knowledge Structure and Intellectual Dynamics. J Pain Res 2022; 15:2337-2350. [PMID: 35996451 PMCID: PMC9391991 DOI: 10.2147/jpr.s372303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
In the last decade, there has been a significant advancement in the area of regional anesthesia (RA). Continuous evaluation of research in any developing field using modern technologies and available software is critical to identify future trends, hot spots, and intellectual dynamics. The current study was designed to bibliometrically evaluate the global research in RA using VOSviewer, MS Excel, and CVS-Scopus bibliographic data (2012–2021). Knowledge structure and intellectual dynamics were analyzed using clustering of keyword co-occurrence. Literature screening in the last decade found 6092 original articles (96.1%) and conference papers (3.9%). The top four countries producing articles were the United States (n = 30.57%), India (7.51), the United Kingdom (7.22%), and Canada (6.06%). A significant positive correlation was found in global publication productivity (R2 = 0.9161). The most productive organizations were Harvard University, the University of Toronto, and the Hospital for Special Surgery – New York. A tremendous collaboration was spotted nationally and internationally, especially in pediatric RA. This comprehensive study, which summarizes and evaluates 6902 original research materials on regional anesthesia, may serve as a resource for anesthesiologists, physicians, researchers, and students.
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Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148696. [PMID: 35886547 PMCID: PMC9320164 DOI: 10.3390/ijerph19148696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.
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Parasternal After Cardiac Surgery (PACS): a prospective, randomised, double-blinded, placebo-controlled trial study protocol for evaluating a continuous bilateral parasternal block with lidocaine after open cardiac surgery through sternotomy. Trials 2022; 23:516. [PMID: 35725494 PMCID: PMC9208208 DOI: 10.1186/s13063-022-06469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimodal analgesia that provides optimal pain treatment with minimal side effects is important for optimal recovery after open cardiac surgery. Regional anaesthesia can be used to block noxious nerve signals. Because sternotomy causes considerable pain that lasts several days, a continuous nerve block is advantageous. Previous studies on continuous sternal wound infusion or parasternal blocks with long-acting local anaesthetics have shown mixed results. This study aims to determine whether a continuous bilateral parasternal block with lidocaine, which is a short-acting local anaesthetic that has a favourable safety/toxicity profile, results in effective analgesia. We hypothesise that a 72-hour continuous parasternal block with 0.5% lidocaine at a rate of 7 ml/hour on each side provides effective analgesia and reduces opioid requirement. We will evaluate whether recovery is enhanced. METHODS In a prospective, randomised, double-blinded manner, 45 patients will receive a continuous parasternal block with either 0.5% lidocaine or saline. The primary endpoint is cumulated intravenous morphine by patient-controlled analgesia at 72 hours. Secondary end-points include the following: (1) the cumulated numerical rating scale (NRS) score recorded three times daily at 72 hours; (2) the cumulated NRS score after two deep breaths three times daily at 72 hours; (3) the NRS score at rest and after two deep breaths at 2, 4, 8 and 12 weeks after surgery; (4) oxycodone requirement at 2, 4, 8 and 12 weeks after surgery; (5) Quality of Recovery-15 score preoperatively compared with that at 24, 48 and 72 hours, and at 2, 4, 8 and 12 weeks after surgery; (6) preoperative peak expiratory flow compared with postoperative daily values for 3 days; and (7) serum concentrations of interleukin-6 and lidocaine at 1, 24, 48 and 72 hours postoperatively compared with preoperative values. DISCUSSION Adequate analgesia is important for quality of care and vital to a rapid recovery after cardiac surgery. This study aims to determine whether a continuous parasternal block with a short-acting local anaesthetic improves analgesia and recovery after open cardiac procedures. TRIAL REGISTRATION The study was registered in the European Clinical Trials Database on 27/9/2019 (registration number: 2018-004672-35).
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Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial. Anesthesiology 2021; 135:864-876. [PMID: 34520520 DOI: 10.1097/aln.0000000000003963] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intrathecal morphine decreases postoperative pain in standard cardiac surgery. Its safety and effectiveness have not been adequately evaluated in minimally invasive cardiac surgery. The authors hypothesized that intrathecal morphine would decrease postoperative morphine consumption after minimally invasive cardiac surgery. METHODS In this randomized, placebo-controlled, double-blinded clinical trial, patients undergoing robotic totally endoscopic coronary artery bypass received either intrathecal morphine (5 mcg/kg) or intrathecal saline before surgery. The primary outcome was postoperative morphine equivalent consumption in the first 24 h after surgery; secondary outcomes included pain scores, side effects, and patient satisfaction. Pain was assessed via visual analog scale at 1, 2, 6, 12, 24, and 48 h after intensive care unit arrival. Opioid-related side effects (nausea/vomiting, pruritus, urinary retention, respiratory depression) were assessed daily. Patient satisfaction was evaluated with the Revised American Pain Society Outcome Questionnaire. RESULTS Seventy-nine patients were randomized to receive intrathecal morphine (n = 37) or intrathecal placebo (n = 42), with 70 analyzed (morphine 33, placebo 37). Intrathecal morphine patients required significantly less median (25th to 75th percentile) morphine equivalents compared to placebo during first postoperative 24 h (28 [16 to 46] mg vs. 59 [41 to 79] mg; difference, -28 [95% CI, -40 to -18]; P < 0.001) and second postoperative 24 h (0 [0 to 2] mg vs. 5 [0 to 6] mg; difference, -3.3 [95% CI, -5 to 0]; P < 0.001), exhibited significantly lower visual analog scale pain scores at rest and cough at all postoperative timepoints (overall treatment effect, -4.1 [95% CI, -4.9 to -3.3] and -4.7 [95% CI, -5.5 to -3.9], respectively; P < 0.001), and percent time in severe pain (10 [0 to 40] vs. 40 [20 to 70]; P = 0.003) during the postoperative period. Mild nausea was more common in the intrathecal morphine group (36% vs. 8%; P = 0.004). CONCLUSIONS When given before induction of anesthesia for totally endoscopic coronary artery bypass, intrathecal morphine decreases use of postoperative opioids and produces significant postoperative analgesia for 48 h. EDITOR’S PERSPECTIVE
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Ultrasound Images Guided under Deep Learning in the Anesthesia Effect of the Regional Nerve Block on Scapular Fracture Surgery. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6231116. [PMID: 34659690 PMCID: PMC8516573 DOI: 10.1155/2021/6231116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
In order to discuss the clinical characteristics of patients with scapular fracture, deep learning model was adopted in ultrasound images of patients to locate the anesthesia point of patients during scapular fracture surgery treated with the regional nerve block. 100 patients with scapular fracture who were hospitalized for emergency treatment in the hospital were recruited. Patients in the algorithm group used ultrasound-guided regional nerve block puncture, and patients in the control group used traditional body surface anatomy for anesthesia positioning. The ultrasound images of the scapula of the contrast group were used for the identification of the deep learning model and analysis of anesthesia acupuncture sites. The ultrasound images of the scapula anatomy of the patients in the contrast group were extracted, and the convolutional neural network model was employed for training and test. Moreover, the model performance was evaluated. It was found that the adoption of deep learning greatly improved the accuracy of the image. It took an average of 7.5 ± 2.07 minutes from the time the puncture needle touched the skin to the completion of the injection in the algorithm group (treated with artificial intelligence ultrasound positioning). The operation time of the control group (anatomical positioning) averaged 10.2 ± 2.62 min. Moreover, there was a significant difference between the two groups (p < 0.05). The method adopted in the contrast group had high positioning accuracy and good anesthesia effect, and the patients had reduced postoperative complications of patients (all P < 0.005). The deep learning model can effectively improve the accuracy of ultrasound images and measure and assist the treatment of future clinical cases of scapular fractures. While improving medical efficiency, it can also accurately identify patient fractures, which has great adoption potential in improving the effect of surgical anesthesia.
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15
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Kaya C, Dost B, Dokmeci O, Yucel SM, Karakaya D. Comparison of Ultrasound-Guided Pectointercostal Fascial Block and Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind Pilot Study. J Cardiothorac Vasc Anesth 2021; 36:2313-2321. [PMID: 34696966 DOI: 10.1053/j.jvca.2021.09.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of the present study was to evaluate morphine consumption and pain scores 24 hours postoperatively to compare the effects of a bilateral pectointercostal fascial block (PIFB) with those of a transversus thoracic muscle plane block (TTMPB) on acute poststernotomy pain in cardiac surgery patients who have undergone median sternotomy. DESIGN Prospective, randomized, double-blinded. SETTING The operating room, intensive care unit, and patient ward at a university hospital. PARTICIPANTS Thirty-nine American Society of Anesthesiologists II-to-III patients aged 18- to-80 years, scheduled for elective cardiac surgery via median sternotomy. INTERVENTIONS Patients randomly were allocated to groups scheduled to receive bilateral ultrasound-guided PIFB or TTMPB. MEASUREMENTS AND MAIN RESULTS The primary outcome was postoperative morphine use within the first 24 hours. Secondary outcomes were the numerical pain rating scale (NRS) scores at rest and during coughing, time of first analgesic demand from the patient-controlled analgesia (PCA) device, and rescue analgesia use. The nausea/vomiting scores, time to extubation, length of stays in intensive care and the hospital, patient satisfaction scores, and complications were also recorded. The first 24-hour morphine use did not significantly differ between the PIFB and TTMPB groups (mean ± standard deviation [95% CI], 13.89 ± 6.80 [10.83-16.95] mg/24 h and 15.08 ± 7.42 [11.83-18.33] mg/24 h, respectively, p = 0.608). No significant difference between the two groups in the NRS scores at rest and during coughing was observed; the groups had similar requirements for rescue analgesia in the first 24 hours (n [%], three [15.8] and seven [35], p = 0.273, respectively). The time from PCA to the first analgesia request was longer in the PIFB than in the TTMPB group (median [interquartile range], 660 [540-900] minutes, and 240 [161-525] minutes, respectively, p = 0.002). CONCLUSIONS PIFB and TTMPB showed similar effectiveness for morphine consumption within 24 hours postoperatively and in pain scores in cardiac surgery patients.
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Affiliation(s)
- Cengiz Kaya
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Ozgur Dokmeci
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Semih Murat Yucel
- Department of Cardiovascular Surgery, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Deniz Karakaya
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Krakowski JC, Hallman MJ, Smeltz AM. Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth 2021; 25:289-300. [PMID: 34416847 PMCID: PMC8669213 DOI: 10.1177/10892532211041320] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.
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Affiliation(s)
| | | | - Alan M Smeltz
- University of North Carolina at Chapel Hill, NC, USA
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17
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Devarajan J, Balasubramanian S, Shariat AN, Bhatt HV. Regional Analgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2021; 25:265-279. [PMID: 33827348 DOI: 10.1177/10892532211002382] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in "Enhanced Recovery after Cardiac Surgery (ERACS)" protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.
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Affiliation(s)
| | | | - Ali N Shariat
- Mount Sinai West and Mount Sinai Morningside Hospitals, New York, NY, USA
| | - Himani V Bhatt
- Mount Sinai Morningside Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Coşarcan SK, Doğan AT, Gurkan Y, Erçelen Ö. Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries. Cureus 2021; 13:e14122. [PMID: 33927930 PMCID: PMC8075756 DOI: 10.7759/cureus.14122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Various regional anesthesia techniques such as thoracic epidural, thoracic paravertebral block, erector spinae plane block (ESPB), parasternal intercostal blocks are used in cardiac surgery for postoperative analgesia. In our study, we investigated the analgesic efficacy of the dual injection technique of ESPB in beating heart coronary bypass surgeries. Methods The records of patients with coronary artery bypass (CABG) surgery in the beating heart at the VKV American Hospital between January and December 2019 were retrospectively analyzed. The data of 30 patients who met the criteria to be included in the study were analyzed. Whether any opioid use is required for maintenance of anesthesia it is recorded. The pain scores of the patients are recorded by the intensive care team and cardiovascular service nurses for the first 48 hours. Results The absence of secondary responses to pain in all surgical periods, including skin incision and sternotomy, and low number of rating scale (NRS) scores in the postoperative 0- to 24-hour period show that the technique we developed can produce effective analgesia. After the 24th postoperative hour, the patients were followed up in the cardiovascular service and there was no opioid use between 24- to 48-hour period. Conclusion Our approach, in which the local anesthetic is applied by approaching the superior costa-transverse ligament (SCTL) in the ESPB, provides an effective analgesia in coronary artery bypass surgeries in the beating heart. The main purpose of our new approach is to increase the amount of local anesthetic in the paravertebral area. We recommend using our modified technique for effective analgesia after CABG surgeries.
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Affiliation(s)
| | | | | | - Ömür Erçelen
- Anesthesiology, Vehbi Koç Vakfı American Hospital, Istanbul, TUR
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19
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Manici M, Salgın B, Gürkan Y, Yavuz Ö, Söğüt MS. Erector Spinae Plane Block for videothoracoscopic left pleurectomy decortication and hyperthermic intrathoracic chemotherapy. J Clin Anesth 2021; 70:110182. [PMID: 33549953 DOI: 10.1016/j.jclinane.2021.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mete Manici
- Department of Anesthesiology and Reanimation, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapı/Istanbul, Turkey.
| | - Belitsu Salgın
- Department of Anesthesiology and Reanimation, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapı/Istanbul, Turkey
| | - Yavuz Gürkan
- Department of Anesthesiology and Reanimation, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapı/Istanbul, Turkey
| | - Ömer Yavuz
- Department of Thoracic Surgery, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapı/Istanbul, Turkey
| | - Muhammet Selman Söğüt
- Department of Anesthesiology and Reanimation, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapı/Istanbul, Turkey
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Marhofer P, Feigl GC, Hopkins PM. Fascial plane blocks in regional anaesthesia: how problematic is simplification? Br J Anaesth 2020; 125:649-651. [DOI: 10.1016/j.bja.2020.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/04/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022] Open
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21
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Huang W, Wang W, Xie W, Chen Z, Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth 2020; 66:109900. [DOI: 10.1016/j.jclinane.2020.109900] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
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22
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Schnabel A, Weibel S, Meißner M, Reichl SU, Kranke P, Meyer-Frießem CH, Zahn PK, Pogatzki-Zahn E. Erector spinae plane block for postoperative pain. Hippokratia 2020. [DOI: 10.1002/14651858.cd013763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Alexander Schnabel
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Stephanie Weibel
- Department of Anesthesiology and Critical Care; University Hospital Wuerzburg; Wuerzburg Germany
| | - Michael Meißner
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Sylvia U Reichl
- Department of Anesthesiology, Perioperative and Intensive Care Medicine; Paracelsus Medical University; Salzburg Austria
| | - Peter Kranke
- Department of Anesthesiology and Critical Care; University Hospital Wuerzburg; Wuerzburg Germany
| | - Christine H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine and Pain Management; BG-Universitätsklinikum Bergmannsheil gGmbH; Bochum Germany
| | - Peter K Zahn
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management; BG-Universitätsklinikum Bergmannsheil gGmbH; Bochum Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
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Moll V, Ward CT, Jabaley CS, O'Reilly-Shah VN, Boorman DW, McKenzie-Brown AM, Halkos ME, Prabhakar A, Pyronneau LR, Schmidt PC. Erector Spinae Regional Anesthesia for Robotic Coronary Artery Bypass Surgery Is Not Associated With Reduced Postoperative Opioid Use: A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2020; 35:2034-2042. [PMID: 33127286 DOI: 10.1053/j.jvca.2020.09.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Regional anesthesia techniques are gaining traction in cardiac surgery. The aim of this study was to compare the analgesic efficacy of erector spinae plane block catheters (ESPBC), serratus anterior plane block catheters (SAPBC), and paravertebral single-shot block (PVB) versus no block after robotic minimally invasive direct coronary artery bypass (MIDCAB). DESIGN This was a retrospective observational study of routinely recorded data. SETTING The study was performed at a single healthcare system. PARTICIPANTS All patients underwent robotic MIDCAB. INTERVENTION Data were analyzed from 346 patients during a 53-month period. The clinical data warehouse was queried for all robotic MIDCAB surgeries. Variables abstracted included type of nerve block, age, sex, use of adjuncts, Society of Thoracic Surgeons predicted short length of stay (PSLOS), total opioid consumption during the 72 hours after surgery, and postoperative hospital length of stay (LOS). The primary outcome was total oral morphine milligram equivalents (MME) consumed during the first 72 hours after surgery. The secondary outcome was hospital LOS. MEASUREMENTS AND MAIN RESULTS In a model adjusting for PSLOS, the authors did not observe an association between ESPBC and the reduction of total administered oral MME within 72 hours after surgery. There was no significant difference in MME when comparing patients who received PVB to patients with ESPBC. Older age and female sex were associated with significantly lower MME. Patients who received ESPBC had a significantly shorter hospital LOS than patients with SAPBC. CONCLUSIONS These findings suggested that postoperative pain after MIDCAB surgery might not be completely covered by ESPBC. Prospective studies are needed to further elucidate the value of this technique for robotic MIDCAB.
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Affiliation(s)
- Vanessa Moll
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA; Institute for Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | - Ceressa T Ward
- Department of Pharmacy, Emory University Hospital Midtown, Atlanta, GA
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - David W Boorman
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | | | - Michael E Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Amit Prabhakar
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | | | - Peter C Schmidt
- Department of Anesthesiology, Division of Pain Medicine, Stanford University School of Medicine, Stanford, CA
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24
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Sepolvere G, Tedesco M, Cristiano L. Ultrasound Parasternal Block as a Novel Approach for Cardiac Sternal Surgery: Could it Be the Safest Strategy? J Cardiothorac Vasc Anesth 2020; 34:2284-2286. [DOI: 10.1053/j.jvca.2020.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
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25
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Aydin ME, Ahiskalioglu A, Ates I, Tor IH, Borulu F, Erguney OD, Celik M, Dogan N. Efficacy of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Postoperative Opioid Consumption After Cardiac Surgery: A Prospective, Randomized, Double-Blind Study. J Cardiothorac Vasc Anesth 2020; 34:2996-3003. [PMID: 32665179 DOI: 10.1053/j.jvca.2020.06.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The postoperative analgesic efficacy of transversus thoracic muscle plane block (TTMPB) has not yet been evaluated sufficiently. This randomized controlled study evaluated the effect of TTMPB on postoperative opioid consumption in patients undergoing cardiac surgery. DESIGN Prospective, randomized, double-blind study. SETTINGS Single institution, academic university hospital. PARTICIPANTS Forty-eight adult patients having cardiac surgery with median sternotomy. INTERVENTIONS Patients were randomly assigned to receive preoperative ultrasound-guided TTMPB with either 20 mL of 0.25% bupivacaine or saline bilaterally. Postoperative analgesia was administered intravenously in the 2 groups 4 times a day with 1000 mg of paracetamol and patient-controlled analgesia with fentanyl. MEASUREMENTS AND MAIN RESULTS The primary outcome was opioid consumption in the first 24 hours. Secondary outcomes included postoperative pain scores, first analgesic requirement time, rescue analgesia, intensive care discharge time, and side effects. Compared with the control group (median 465 µg, interquartile range 415-585), the transversus thoracic muscle plane (TTMP) group (median 255 µg, interquartile range 235-305) had reduced postoperative 24-hour opioid consumption (p < 0.001). Pain scores were significantly lower in the TTMP group compared with the control group up to 12 hours after surgery both at rest and active movement (p < 0.001). Compared with the TTMP group, the proportion of postoperative nausea and pruritus was statistically higher in the control group (p < 0.001). CONCLUSIONS A single preoperative TTMPB provided effective analgesia and decreased opioid requirements in patients undergoing cardiac surgery.
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Affiliation(s)
- Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey.
| | - Irem Ates
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ibrahim Hakki Tor
- Department of Anesthesiology and Reanimation, University of Health Sciences School of Medicine, Erzurum, Turkey
| | - Ferhat Borulu
- Department of Cardiovascular Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ozlem Dilara Erguney
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Nazim Dogan
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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26
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Guay J, Kopp SL. Postoperative Pain Management for Cardiac Surgery: Do We Need New Blocks? J Cardiothorac Vasc Anesth 2020; 34:2994-2995. [PMID: 32636104 DOI: 10.1053/j.jvca.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Joanne Guay
- Teaching and Research Unit, Health Sciences, University of Quebec in Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada; Department of Anesthesiology, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada; Department of Anesthesiology and Critical Care, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
| | - Sandra L Kopp
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN
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27
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Alharbi HA, Albabtain MA, Alobiad N, Aba Alhasan J, Alruhaimi M, Alnefisah M, Alateeq S, Alghosoon H, Alarfaj SJ, Arafat AA, Algarni KD. Pain perception assessment using the short-form McGill pain questionnaire after cardiac surgery. Saudi J Anaesth 2020; 14:343-348. [PMID: 32934627 PMCID: PMC7458021 DOI: 10.4103/sja.sja_34_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Pain management remains an integral part of patient care after cardiac surgery, and it required proper pain assessment. The aim of the study was to assess pain perception using validated Arabic version of the short-form McGill Pain Questionnaire (SF-MPQ) and to identify analgesics prescribing patterns post cardiac surgery. Methods: This is a prospective study conducted in an adult cardiac critical care unit of a tertiary cardiac center from September 2018 to March 2019. The study enrolled 74 patients who underwent cardiac surgical procedures through a median sternotomy. Results: The mean age of our patients was 57 ± 11 years and 47 (63.5%) were males. Patients described post-cardiac surgery pain as heavy (n = 37; 50%) and tiring-exhausting (n = 49; 66%), mainly at the site of incision (n = 20; 27%). Pain intensity at day 1 according to pain rating index (PRI) and numerical rating scale (NRS) was 7 (25th, 75th percentiles: 2.8–15) and 6 (3–8), respectively. There was a significant change in pain intensity score between 2 days of assessment (PRI: 7 [2.8–15] vs 5 [2–11] P = 0.010; NRS: 6 (3–8) vs 5 (2–8), P = 0.021]). The most common analgesics prescribed were paracetamol (39%) and a combination of tramadol and paracetamol (33.8%). Conclusion: Pain decreased the second day after cardiac surgery compared to day 1. Paracetamol was the most prescribed analgesic; however, there was an underutilization which might be affected by insufficient pain reporting. Future improvement could focus on multimodal pain management and proper communication of pain experience.
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Affiliation(s)
- Hussam A Alharbi
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, KSA
| | | | - Nourah Alobiad
- College of Pharmacy, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA
| | - Jomanah Aba Alhasan
- College of Pharmacy, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA
| | - Maram Alruhaimi
- College of Pharmacy, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA
| | - Muzun Alnefisah
- College of Pharmacy, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA
| | - Samar Alateeq
- College of Pharmacy, Princess Nourah Bint Abdul Rahman University, Riyadh, KSA
| | - Haneen Alghosoon
- Department of Research, Prince Sultan Cardiac Centre, Riyadh, KSA
| | - Sumaiah J Alarfaj
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, KSA
| | - Amr A Arafat
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, KSA.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Khaled D Algarni
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, KSA.,Department of Cardiac Science, King Saud University, Riyadh, KSA
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