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Fusco P, Nazzarro E, Petroni GM, DE Sanctis F, Scimia P, Marinangeli F. Serratus plane block and parasternal block associated to achieve greater effectiveness and safety in cardioverter-defibrillator implantation. Minerva Anestesiol 2024; 90:709-711. [PMID: 39021145 DOI: 10.23736/s0375-9393.24.18088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit, SS. Filippo e Nicola Hospital, Avezzano, L'Aquila, Italy
| | - Emanuele Nazzarro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy -
| | - Gian M Petroni
- Department of Anesthesia and Intensive Care Unit, S. Maria Hospital, Terni, Italy
| | - Francesca DE Sanctis
- Department of Anesthesia and Intensive Care Unit, S. Maria Hospital, Terni, Italy
| | - Paolo Scimia
- Department of Anesthesia and Intensive Care Unit, G. Mazzini Hospital, Teramo, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Capuano P, Sepolvere G, Toscano A, Scimia P, Silvetti S, Tedesco M, Gentili L, Martucci G, Burgio G. Fascial plane blocks for cardiothoracic surgery: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:20. [PMID: 38468350 PMCID: PMC10926596 DOI: 10.1186/s44158-024-00155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
In recent years, there has been a growing awareness of the limitations and risks associated with the overreliance on opioids in various surgical procedures, including cardiothoracic surgery.This shift on pain management toward reducing reliance on opioids, together with need to improve patient outcomes, alleviate suffering, gain early mobilization after surgery, reduce hospital stay, and improve patient satisfaction and functional recovery, has led to the development and widespread implementation of enhanced recovery after surgery (ERAS) protocols.In this context, fascial plane blocks are emerging as part of a multimodal analgesic in cardiac surgery and as alternatives to conventional neuraxial blocks for thoracic surgery, and there is a growing body of evidence suggesting their effectiveness and safety in providing pain relief for these procedures. In this review, we discuss the most common fascial plane block techniques used in the field of cardiothoracic surgery, offering a comprehensive overview of regional anesthesia techniques and presenting the latest evidence on the use of chest wall plane blocks specifically in this surgical setting.
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Affiliation(s)
- Paolo Capuano
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy.
| | - Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa Di Cura San Michele, Maddaloni, Caserta, Italy
| | - Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, "Città Della Salute E Della Scienza" Hospital, Turin, Italy
| | - Paolo Scimia
- Intensive Care Unit, Department of Anesthesia, G. Mazzini Hospital, Teramo, Italy
| | - Simona Silvetti
- Department of Cardioanesthesia and Intensive Care, Policlinico San Martino IRCCS Hospital - IRCCS Cardiovascular Network, Genoa, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Luca Gentili
- Intensive Care Unit, Department of Anesthesia, S. Maria Goretti Hospital, Latina, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (IRCCS-ISMETT), UPMCI (University of Pittsburgh Medical Center Italy), Palermo, Italy
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Mansour MA, Mahmoud HE, Fakhry DM, Kassim DY. Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study. BMC Anesthesiol 2024; 24:63. [PMID: 38341525 PMCID: PMC10858555 DOI: 10.1186/s12871-024-02432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is an association exists between cardiac surgery, performed through median sternotomy, and a considerable postoperative pain. OBJECTIVES The aim of the current study is to compare the effects of transversus thoracic muscle plane block (TTMPB) and pecto-intercostal fascial plane block (PIFB) upon postoperative opioid consumption among the patients who underwent open cardiac surgery. METHODS The present prospective, randomized, comparative study was conducted among 80 patients who underwent elective on-pump cardiac surgery with sternotomy. The subjects were randomly assigned to two groups with each group containing 40 individuals. For the TTMPB group, bilateral ultrasound-guided TTMPB was adopted in which 20 ml of 0.25% bupivacaine was used on each side. In case of PIFB group, bilateral ultrasound-guided PIFB was adopted with the application of 20 ml of 0.25% bupivacaine on each side. The researchers recorded the first time for rescue analgesia, the overall dosage of rescue analgesia administered in the first 24 h after the operation and the postoperative complications. RESULTS The PIFB group took significantly longer time to raise the first request for rescue analgesia (7.8 ± 1.7 h) than the TTMPB group (6.7 ± 1.4 h). Likewise, the PIFB group subjects had a remarkably lower 'overall morphine usage' in the first 24 h after the operation (4.8 ± 1.0 mg) than TTMPB group (7.8 ± 2.0 mg). CONCLUSION Bilateral ultrasound-guided PIFB provided a longer time for the first analgesic demand than bilateral ultrasound-guided TTMPB in patients undergoing open cardiac surgery. In addition to this, the PIFB reported less postoperative morphine usage than the TTMPB and increases satisfaction in these patients. TRIAL REGISTRATION This study was registered at Clinical Trials.gov on 28/11/2022 (registration number: NCT05627869).
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Affiliation(s)
- Mariana AbdElSayed Mansour
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Hatem ElMoutaz Mahmoud
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Mahmoud Fakhry
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Dina Yehia Kassim
- Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Francis L, Condrey J, Wolla C, Kelly T, Wolf B, McFadden R, Brown A, Zeigler S, Wilson SH. Parasternal intercostal plane block catheters for cardiac surgery: a retrospective, propensity weighted, cohort study. Pain Manag 2023; 13:405-414. [PMID: 37615072 DOI: 10.2217/pmt-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Aim: Anesthesia for cardiac surgery has evolved toward fast-track recovery strategies incorporating non opioid analgesics and regional anesthesia. Materials & methods: This retrospective cohort study compared opioid consumption, pain scores and length of stay in patients who underwent cardiac surgery via median sternotomy and did or did not receive preoperative parasternal intercostal plane block catheters with postoperative ropivacaine infusions. Results: Postoperative opioid consumption and postoperative pain scores did not differ. Blocks were associated with decreased intraoperative opioids and reduced length of stay in the intensive care unit and hospital. Conclusion: Parasternal intercostal plane block catheters were not associated with decreased postoperative opioid consumption or pain scores, but were associated with reduced intraoperative opioids and length of stay.
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Affiliation(s)
- Loren Francis
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Jackson Condrey
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Christopher Wolla
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Tara Kelly
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Bethany Wolf
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Ryan McFadden
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Adam Brown
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Sanford Zeigler
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
| | - Sylvia H Wilson
- Medical University of South Carolina, 25 Courtenay Drive, Suite 4200 MSC 420 Charleston, SC 29525, USA
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Droghetti A, Pecora D, Maffè S, Badolati S, Pepi P, Nicolis D, Lupo P, Lovecchio M, Valsecchi S, Ottaviano L. "Shift and cover technique": conservative management of complications for the rescue of S-ICD subcutaneous implantable defibrillator systems. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01312-y. [PMID: 35927601 DOI: 10.1007/s10840-022-01312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them. METHODS The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our "shift and cover" approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia. RESULTS Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit. CONCLUSIONS The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.
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Affiliation(s)
- Andrea Droghetti
- Thoracic Surgery Division, ASST Mantova, Viale Lago Paiolo 10, 46100, Mantua, Italy.
| | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Stefano Maffè
- Division of Cardiology, Ospedale SS, Trinità, Borgomanero Hospital, Novara, Italy
| | - Sandra Badolati
- Department of Cardiology, S. Andrea Hospital, La Spezia, Italy
| | | | | | - Pierpaolo Lupo
- Arrhythmia and Electrophysiology Center,I.R.C.C.S. MultiMedica, Sesto San Giovanni (MI), Italy
| | | | | | - Luca Ottaviano
- Arrhythmia and Electrophysiology unit, Cardiothoracic Department Clinical Institute S. Ambrogio, Milan, Italy
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Zhang Y, Min J, Chen S. Perioperative Pain Management With Bilateral Pecto-intercostal Fascial Block in Pediatric Patients Undergoing Open Cardiac Surgery. Front Cardiovasc Med 2022; 9:825945. [PMID: 35811718 PMCID: PMC9256953 DOI: 10.3389/fcvm.2022.825945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
Purposes Pediatric open cardiac surgical patients usually suffer from acute pain after operation. The current work aimed to explore the impact of bilateral PIFB in children suffering from open cardiac surgery. Methods This work randomized altogether 110 child patients as bilateral PIFB (PIF) and non-nerve block (SAL) groups. This work adopted post-operative pain at exercise and rest statuses as the primary endpoint, whereas time-to-drain removal/extubation/initial defecation, intraoperative/post-operative fentanyl use, and length of ICU and hospital stay as the secondary endpoints. Results MOPS were significantly higher at 24-h post-operatively at coughing and rest statuses in SAL group compared with PIF group. Meanwhile, PIF group exhibited markedly lower intraoperative/post-operative fentanyl use amounts, as well as markedly reduced time-to-extubation/initial flatus, and length of ICU/hospital stay. Conclusion Bilateral PIFB in pediatric open cardiac surgical patients provide effective analgesia and lower the length of hospital stay.
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Elders J, AlHashimi H, Gomes M, Panhuizen I, van Kuijk S, Vernooy K. Subcutaneous ICD implantation under ultrasound-guided serratus anterior plane block: Single-center experience in the Netherlands. IJC HEART & VASCULATURE 2022; 38:100949. [PMID: 35028411 PMCID: PMC8739453 DOI: 10.1016/j.ijcha.2021.100949] [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: 10/21/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
Introduction To avoid general anesthesia (GA) and improve postoperative pain management for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation there is a growing interest for alternative methods. We describe the first experience in the Netherlands of S-ICD implantation under Ultrasound-guided Serratus Anterior Plane Block (US-SAPB). Methods US-SAPB was performed 1 hour before S-ICD implantation. The two-incision technique was used and a pocket beneath the latissimus dorsi muscle was surgically created. Lidocaine was used to provide anesthesia of the skin. Sedation during defibrillation testing (DFT) was induced by intravenous Propofol. Periprocedural pain experience was monitored using the Numerical Rating Scale for Pain (NRS-Pain). The results were compared with a control group of patients undergoing S-ICD implantation under GA. Results Forty consecutive patients (29 Male/11 Female, median age 59 years (range 34–84 years), median body mass index 26 (range 17–41) underwent S-ICD implantation; Twenty patients under US-SAPB and twenty under GA. Median procedure time was 42 min. (range 28–60 min.) with no differences between both groups. In both groups implantations went successful and defibrillation was accomplished using 65 J. US-SAPB was successful in 19 of the 20 patients and GA was successful in all cases. Median NRS-Pain in the US-SAPB group was 2 (range 2–6) and in the GA group 4 (range 2–6). In the US-SAPB group 5 patients required additional opioids postoperatively compared to 10 patients in the GA group. Conclusions S-ICD implantation under US-SAPB is feasible, safe and reduces the need for postoperative opioids significantly. S-ICD implantation under US-SAPB seems a good alternative for GA.
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Affiliation(s)
- Jan Elders
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Hisham AlHashimi
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Marc Gomes
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Ivo Panhuizen
- Department of Anesthesiology, Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Guarracini F, Marini M, Strazzanti M, Bonmassari R, Guarracini S, Di Mauro M, Droghetti A. Successful implantation of S-ICD using the intermuscular two-incision technique in a patient with severe pectus excavatum. Clin Case Rep 2021; 9:e05143. [PMID: 34853691 PMCID: PMC8617332 DOI: 10.1002/ccr3.5143] [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] [Received: 08/07/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022] Open
Abstract
A patient with severe pectus excavatum, dilated ischemic heart disease, and indication for defibrillator implantation for primary prevention of sudden death underwent successful ultrasound-guided serratus anterior plane block and parasternal block with intermuscular two-incision technique implantation with no complications. At follow-up, all the parameters resulted stable with excellent signal sensing.
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Affiliation(s)
| | | | | | | | | | - Michele Di Mauro
- Cardio‐Thoracic Surgery Unit, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
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Sepolvere G, Coppolino F, Tedesco M, Cristiano L. Ultrasound-guided parasternal blocks: techniques, clinical indications and future prospects: a narrative review. Minerva Anestesiol 2021; 87:1338-1346. [PMID: 34633167 DOI: 10.23736/s0375-9393.21.15599-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fascial plane blocks represent anesthetic procedures performed to manage perioperative and chronic pain. Recently, many fascial blocks techniques have been described increasing their field of applications. They offer anesthetic and analgesic efficacy, easy of execution and low risk of complications. The newest techniques recently described are the ultrasound parasternal blocks (USPSB) which provide analgesia to the antero-medial chest wall. In particular, the antero-medial chest wall blocks are performed to provide analgesia and anesthesia in several and different surgeries such as median sternotomy, breast surgery, implantable cardioverter-defibrillator implantation and in the management of acute and chronic pain. The nervous target for these blocks is represented by the anterior branches of the intercostal nerves which enter the intercostal (ICM) and pectoralis major (PMM) muscles innervating the antero-medial region of chest wall, the main cause of poststernotomy pain. Local anesthetic is injected deep to PMM and superficial to the ICM or between the internal thoracic muscle (IIM) and transversus thoracis muscle (TTM). So, essentially these blocks may be described as superficial or deep parasternal-intercostal plane blocks, based on where the target nerves are hunted. Even if they all provide analgesia to the antero-medial chest wall, the anatomical injection site represents the main peculiarity that differentiates these techniques. To date, a common nomenclature for antero-medial chest wall blocks or parasternal-intercostal plane blocks is not yet well defined and a standardized nomenclature is needed to ensure an adequate communication among anesthesiologists.
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Affiliation(s)
- Giuseppe Sepolvere
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy -
| | - Francesco Coppolino
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Loredana Cristiano
- Intensive Care Unit, Department of Anesthesia and Cardiac Surgery, San Michele Hospital, Maddaloni, Caserta, Italy
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Zhang Y, Min J, Chen S. Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial. PAIN MEDICINE 2021; 23:440-447. [PMID: 34601602 DOI: 10.1093/pm/pnab291] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimal analgesia regimen after open cardiac surgery was unclear. The aim of this study was to investigate the beneficial effects of continuous Pecto-Intercostal Fascial Block (PIFB) blocks initiated before surgery on outcomes following open cardiac surgery. METHODS A group of 116 patients were randomly allocated to either receive bilateral continuous PIFB (PIF group) or the same block with saline (SAL group). The primary endpoint was postoperative pain at 4, 8, 16, 24, 48, and 72 h after extubation at rest and exercise. The secondary outcome measures included analgesia requirements (sufentanil and flurbiprofen consumption), time to extubation, length of stay in the ICU, incidence of postoperative nausea and vomiting (PONV), time until return of bowel function, time to mobilization, urinary catheter removal and the length of hospital stay. RESULTS The length of stay in the ICU (29 ± 7 h vs 13 ± 4 h, p < 0.01) and length of hospital stay (8.9 ± 0.9 d vs 6.5 ± 1.1 d, p < 0.01) was significantly longer in the SAL group than in the PIF group. Resting pain scores (2 h after extubation : 1.1 vs 3.3, p < 0.01; 4 h after extubation : 1.0 vs 3.5, p < 0.01; 8 h after extubation : 1.2 vs 3.7, p < 0.01; 16 h after extubation : 1.3 vs 3.7, p < 0.01; 24 h after extubation : 1.4 vs 2.8, p < 0.01; 48 h after extubation : 0.9 vs 2.2, p < 0.01; 72 h after extubation : 0.8 vs 2.1, p < 0.01) and dynamic pain scores (2 h after extubation : 1.4 vs 3.7, p < 0.01; 4 h after extubation : 1.3 vs 3.8, p < 0.01; 8 h after extubation : 1.4 vs 3.5, p < 0.01; 16 h after extubation : 1.2 vs 3.4, p < 0.01; 24 h after extubation : 1.1 vs 3.1, p < 0.01; 48 h after extubation : 1.0 vs 2.9, p < 0.01; 72 h after extubation: 0.9 vs 2.8, p < 0.01) were significantly lower in PIF group compared with SAL group at all time points. The PIF group required significantly less intraoperative (123 ± 32 μg vs 63 ± 16 μg, p < 0.01) and postoperative sufentanil (102 ± 22 μg vs 52 ± 17 μg, p < 0.01) consumption, postoperative flurbiprofen consumption (350 ± 100 mg vs 100 ± 100 mg, p < 0.01) than the SAL groups. Time to extubation (8.9 ± 2.4 h vs 3.2 ± 1.3 h, p < 0.01), time to first flatus (43 ± 6 h vs 30 ± 7 h, p < 0.01), time until mobilization (35 ± 5 h vs 24 ± 7 h, p < 0.01), time until urinary catheter removal (47 ± 9 h vs 31 ± 4 h, p < 0.01) was significantly earlier in the PIF group than in the SAL group. The incidence of PONV was significantly lower in the PIF group (9.1% vs 27.3%, p < 0.01). CONCLUSION Bilateral continuous PIFB reduced the length of hospital stay and provided effective postoperative pain for three days.
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Affiliation(s)
- Yang Zhang
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jia Min
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shibiao Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China
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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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Zhang Y, Gong H, Zhan B, Chen S. Effects of bilateral Pecto-intercostal Fascial Block for perioperative pain management in patients undergoing open cardiac surgery: a prospective randomized study. BMC Anesthesiol 2021; 21:175. [PMID: 34157970 PMCID: PMC8218527 DOI: 10.1186/s12871-021-01391-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open cardiac surgical patients may experience severe acute poststernotomy pain. The ultrasound-guided Pecto-intercostal Fascial Block (PIFB) can cover anterior branches of intercostal nerves from T2 to T6. The aim of this study was to investigate the effect of bilateral PIFB in patients undergoing open cardiac surgery. METHODS A group of 108 patients were randomly allocated to either receive bilateral PIFB (PIFB group) or no nerve block (SALI group). The primary endpoint was postoperative pain. The secondary outcome measures included intraoperative and postoperative sufentanil and parecoxib consumption, time to extubation, time to first feces, length of stay in the ICU and the length of hospital stay. Insulin, glucose, insulin resistance and interleukin (IL)-6 at 1, 2, 3 days after surgery were mearsured. The homeostasis model assessment (HOMA-IR) was used to measure perioperative insulin resistance. RESULTS The PIFB group reported significantly less sufentanil and parecoxib consumption than the SALI group. Compared to the PIFB group, the SALI group had higher Numerical Rating Scale (NRS) pain scores at 24 h after operation both at rest and during coughing. The time to extubation, length of stay in the ICU and length of hospital stay were significantly decreased in the PIFB group compared with the SALI group. The PIFB group had a lower insulin, glucose, IL-6, HOMA-IR level than the SALI group 3 days after surgery. CONCLUSION Bilateral PIFB provides effective analgesia and accelerates recovery in patients undergoing open cardiac surgery. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry ( ChiCTR 2000030609 ) on 08/03/2020.
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Affiliation(s)
- Yang Zhang
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang, 330006, Jiangxi, China
| | - Haixia Gong
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang, 330006, Jiangxi, China
| | - Biming Zhan
- Department of cardiology, The second Affiliated Hospital of Nanchang University, NO.1 minde Street, Nanchang, 330006, Jiangxi, China
| | - Shibiao Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang, 330006, Jiangxi, China.
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Sepolvere G, Tognù A, Tedesco M, Coppolino F, Cristiano L. Avoiding the Internal Mammary Artery During Parasternal Blocks: Ultrasound Identification and Technique Considerations. J Cardiothorac Vasc Anesth 2020; 35:1594-1602. [PMID: 33293216 DOI: 10.1053/j.jvca.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022]
Abstract
Fascial plane chest wall blocks are an integral component to optimal multimodal postoperative analgesia in breast and cardiothoracic surgery, facilitating faster functional recovery and earlier discharge. Pectoral nerves block and serratus plane block have been used to treat postsurgical pain after breast and cardiothoracic surgeries; however, they cannot be used to anesthetize the anterior chest wall. Ultrasound parasternal block, or pectointercostal fascial block and transversus thoracis muscle plane block are two novel ultrasound-guided anesthetic and analgesic techniques that block the anterior cutaneous branches T2 to T6 intercostal nerves, providing anesthesia and analgesia to the anterior chest wall. Ultrasound parasternal block/pectointercostal fascial block and transversus thoracis muscle plane block are performed in the region of the internal mammary artery and could be considered to treat post-thoracotomy pain. This anatomic region is innervated by the anterior cutaneous branches T2-to-T6 intercostal nerves, which are obliterated during cardiac surgery artery harvesting. At the level of the fourth parasternal rib interspace, the internal mammary artery can be identified between the internal intercostal muscle and transversus thoracis muscle as a longitudinal pulsatile structure approximately 1.5 cm from the lateral border of the sternum. The transversus thoracis muscle is variable in many people and, thus, is an unreliable target and is difficult to visualize with ultrasound. Moreover, patients with a history of coronary artery bypass grafting could have tissue disruption in the transversus thoracis plane because of the internal mammary artery harvest, making transversus thoracis muscle identification more difficult. Despite ultrasound parasternal block and transversus thoracis muscle plane block having good safety profiles and reduced risk of complications, pneumothorax, local anesthetic systemic toxicity, and internal mammary artery injury or hematoma should be considered. If the block is performed before cardiac surgery, both the right and left internal mammary arteries could be damaged. The injury could render the internal mammary artery unusable for bypass grafting. If the block is performed after left internal mammary artery harvesting at the end of coronary artery bypass grafting, only the right internal mammary artery could be damaged. In patients in whom the internal mammary artery has been surgically used and the transversus thoracis muscle is difficult to visualize, ultrasound parasternal block should be considered. In patients in whom the internal mammary artery could be difficult to visualize or considering that it is in the vicinity of the transversus thoracis muscle plane block target and that the transversus thoracis muscle is difficult to visualize with ultrasound after internal mammary artery harvesting, then ultrasound parasternal block should be considered. The authors believe that ultrasound parasternal block is the safer regional technique for protecting the internal mammary artery and the pleura because it is more superficial. For this reason, ultrasound parasternal block also could be performed by inexperienced anesthesiologists. Although ultrasound parasternal block is more superficial, its superiority in terms of safety is yet to be proven. Additional studies are warranted to validate the authors' hypothesis.
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Affiliation(s)
- Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy.
| | - Andrea Tognù
- Department of Intensive Care Unit and Pain Therapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Francesco Coppolino
- Department of Woman, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Loredana Cristiano
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy
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Uran C, Giojelli A, Borgogna DA, Morello G, Marullo F, Iodice P, Greco A, Accogli M, Guido A, Palmisano P. Ultrasound-guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:705-712. [PMID: 32420626 DOI: 10.1111/pace.13944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The standard approach to subcutaneous defibrillator (S-ICD) implantation often requires general anesthesia or anesthesiologist-delivered deep sedation. Ultrasound-guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S-ICD implantation. In this pilot study, we compared the double-block approach (SAPB + PSB) with the single-block approach (SAPB only) and with the standard approach involving local anesthesia and sedation. METHODS We prospectively enrolled 22 patients undergoing S-ICD implantation: in 10, the single-block approach was adopted; in 12, the double-block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S-ICD implantation under standard local anesthesia and sedation in the previous 6 months. Intra- and postprocedural data, including patient-reported pain intensity, were collected and compared in the three study groups. RESULTS The double-block approach was associated with a shorter procedure duration than the single-block and standard approaches (63.3 ± 7.9 vs 70.1 ± 6.8 vs 76.9 ± 7.8 min; P < .05) and with a lower dose of local an aesthetic for infiltration (18.9 ± 1.7 vs 27.5 ± 4.6 vs 44.6 ± 4.0 cc; P < .001). Both the double- and single-block approaches were associated with lower pain intensity at the device pocket and the lateral tunneling site (P < .05). The double-block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunneling site (P < .05). CONCLUSIONS In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intraoperative pain during S-ICD implantation. In addition, this approach resulted in shorter procedure durations.
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Affiliation(s)
- Carlo Uran
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Angela Giojelli
- Diagnostic Imaging Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Donato Antonio Borgogna
- Anesthesia and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Gerardo Morello
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Flavio Marullo
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Pietro Iodice
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Angelo Greco
- Anesthesia and Intensive Care Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Michele Accogli
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Alessandro Guido
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Pietro Palmisano
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
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Scimia P, Fusco P. The ultrasound-guided Parasternal block: the story continues. Minerva Anestesiol 2020; 86:790-791. [PMID: 32154691 DOI: 10.23736/s0375-9393.20.14535-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Scimia
- Department of Anesthesia and Intensive Care Unit, Giuseppe Mazzini Hospital, Teramo, Italy -
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
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Sepolvere G, Fusco P, Tedesco M, Scimia P. Bilateral ultrasound-guided parasternal block for postoperative analgesia in cardiac surgery: could it be the safest strategy? Reg Anesth Pain Med 2020; 45:316-317. [DOI: 10.1136/rapm-2019-100872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
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17
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Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Elvira Mocavero P, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Debonis S, Scimia P, Lovecchio M, Valsecchi S, Diemberger I, Droghetti A. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case‐control analysis. J Cardiovasc Electrophysiol 2019; 31:144-149. [DOI: 10.1111/jce.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Ziacchi
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | | | | | | | - Cristian Martignani
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | - Paola Elvira Mocavero
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi HospitalNaples Italy
| | - Fabrizio Caravati
- Division of Cardiology“Circolo e Fondazione Macchi” HospitalVarese Italy
| | - Nadia Della Cioppa
- Division of CardiologySecond University of Naples, Monaldi HospitalNaples Italy
| | | | | | | | | | | | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST CremonaCremona Italy
| | | | | | - Igor Diemberger
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
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