Background: Thoracic retrolaminar block (TRLB) is a relatively new regional analgesic technique that can be used as an alternative to thoracic paravertebral block. This study aimed to evaluate the postoperative analgesic effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision.Methods: Sixty-six patients aged 2 to 8 years undergoing cardiac open cardiac surgery via median sternotomy incision were recruited. In the TRLB group, 0.25% bupivacaine 0.4mL/kg was injected into the retrolaminar space on each side at the level of T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was the 24h post-extubation fentanyl consumption. The secondary outcome measures were total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS) and time to extubation.
Results:The mean±SD total intraoperative fentanyl requirements (μg/kg) and the 24h postextubation fentanyl consumption (μg/kg) were significantly lower (P<0.001) in the TRLB group (9.3±1.2&6.9±2.1 respectively) than the control group (12.5±1.4&16.6±2.8 respectively). The median (Q1, Q3) time (h) of extubation and the mean±SD time (h) of ICU length of stay were significantly shorter (P<0.001) in the TRLB group (2 [1-3] &23.8±3.2 respectively) in comparison with the control group (6 [4.5-6] & 30.3±3.2 respectively). MOPS was significantly lower (P<0.05) in the TRLB group than the control group at the following time points, 0, 2, 4, 8, 12 and16 hours after extubation. Conclusions: Bilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.
Background
Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU).
Methods
In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission.
Results
The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths.
Conclusions
From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.
Background:In pediatric cardiac surgery, the use of multimodal analgesia, including a regional analgesic technique reduces opioid consumption and adverse effects. Objective: This study aimed to compare the effect of the ultrasound-guided bilateral thoracic erector spinae plane block (ESPB) and paravertebral block (PVB) on postoperative pain score and opioid consumption. Methods: This is a single center randomized, controlled, double-blinded, non-inferiority study. A total of 50 eligible pediatric patients, aged 2-10 years, scheduled for elective open cardiac surgery via median sternotomy were recruited. Bilateral ultrasound-guided thoracic ESPB at T4 was performed in patients included in the ESPB group and bilateral PVB was done in patients included in the PVB group by injecting 0.25% bupivacaine 0.4mL/kg on each side. The primary end point was fentanyl consumption during the first 24 h following extubation, while the secondary endpoints were postoperative modified objective pain score (MOPS), time needed to perform the block, intraoperative fentanyl consumption, time to the first analgesic request and the incidence of mechanical complications. Results: Both ESPB and PVB similarly reduced fentanyl consumption during the first 24 h following extubation and MOPS at all time points of measurement. Intraoperative fentanyl consumption and time to first analgesic request were similar in both ESPB and PVB group. The time needed to perform the block was significantly shorter in the ESPB group than the PVB group. Mechanical complications of needle advancement did not occur in any patients. Conclusion: In pediatric patients scheduled for open cardiac surgery via median sternotomy, ultrasound-guided bilateral thoracic ESPB is non-inferior to PVB in providing postoperative analgesia in terms of opioid consumption and pain score. Moreover, ESPB is easier and its performance requires a shorter period than PVB.
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