A case series of continuous paravertebral block in minimally invasive cardiac surgery

Abstract

BackgroundMinimally invasive cardiac surgery (MICS), via minithoracotomy, is thought to be a fast track to extubation and recovery after surgery. For this, good coverage analgesia is essential. Epidural anesthesia, a standard technique for thoracic surgery, has high risk of complications, such as epidural abscess and spinal hematoma in open-heart surgery. Based on the hypothesis that continuous paravertebral block (CPVB), a less invasive regional anesthetic technique, is safe and effective in open-heart surgery, we applied CPVB to MICS with thoracotomy.FindingsTo assess whether CPVB could be used in open-heart surgery with fewer potential complications, we investigated our medical records of the 87 adult patients who underwent MICS at Akashi Medical Center, Hyogo, Japan, between March 2009 and May 2016. We collected data of CPVB-related complications, postextubation respiratory failure, duration of intubation, and other analgesic use from hospital clinical records. We observed no severe CPVB-related complications, such as hematoma, neuropathy, or abscess. PT-INR longer than 1.1 was associated with CPVB-related minor bleeding. Forty-three patients (47.4%) were extubated within 1 h after surgery, and there were no postextubation respiratory failures in any patients.ConclusionsWe observed no cases of severe CPVB-related complications or postextubation respiratory failure in any of our patients who underwent MICS. Preoperative prolongation of PT-INR was associated with CPVB-related minor bleeding.

Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair — a randomized controlled trial

“…The primary outcome of our study was the oxycodone consumption via PCA during the first 24 postoperative hours. Patients in the PECS + ESP group used significantly less oxycodone than individuals in the ESP group: 12 [IQR: 6-16] mg vs. 20 [IQR: 18-29] mg or 18 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 30 [27-43.5] ME (p = 0.0004) ( Fig. 6).…”

“…Among many regional anesthesia techniques for patients undergoing cardiac surgery, thoracic epidural analgesia (TEA) is associated with reduced incidences of cardiovascular events and infections, lower cost, and shortened length of hospital stay [5][6][7]. Thoracic paravertebral block (PVB) exhibits similar effectiveness to that of TEA for analgesia after cardiothoracic surgery [8,9]. Other regional anesthesia techniques are not wellestablished in cardiothoracic surgery [10].…”

Efficacy of paravertebral block in “Fast-tracking” pediatric cardiac surgery - Experiences from a tertiary care center

“…had reported the safety of continuous PVB in a case series of patients who underwent minimally invasive cardiac surgery. [ 14 ]…”

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

“…While the risk profile of PVB placement is generally low with no reports of paravertebral, epidural, or spinal hematoma, superficial minor bleeding was detected at the catheter site (category A3 evidence, 167 category B2 evidence, 175 and category B3 evidence 176 ).…”

“…While the risk profile of PVB placement is generally low with no reports of paravertebral, epidural, or spinal hematoma, superficial minor bleeding was detected at the catheter site (category A3 evidence, 167 category B2 evidence, 175 and category B3 evidence 176 ). Other complications reported were failed block, dural puncture, blood vessel puncture, pneumothorax, transient paresthesia, and somnolence (category B2 evidence).…”