Analgesia paravertebral continua frente a analgesia intravenosa en cirugía cardiaca mínimamente invasiva por minitoracotomía

Carmona, Paula; Llagunes, J.; Casanova, I.; Mateo, E.; Cánovas, Sergio; Martín, E.; Marqués, J.I.; Peña, J.J.; Andrés, José De

doi:10.1016/j.redar.2012.04.014

Cited by 15 publications

(8 citation statements)

References 24 publications

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“…Other potential techniques that could be used in patients after mitral and/or tricuspid valve repair via minithoracotomy include PVB and TEA. PVB seems superior to TEA for this type of surgery because its analgesic area is limited to the operated side [1,21]. Data to compare pain relief between ESP and PVB are lacking, but we suspect that their efficacy is similar.…”

Section: Discussionmentioning

confidence: 98%

“…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).…”

Section: Oxycodone Consumptionmentioning

confidence: 99%

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

et al. 2020

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Background: Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks. Methods: This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry. Results: Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6-16] mg vs. 20 [IQR: 18-29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry. Conclusions: The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/ tricuspid valve repair via mini-thoracotomy. Trial registration: The study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485.

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Section: Discussionmentioning

confidence: 98%

Section: Oxycodone Consumptionmentioning

confidence: 99%

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

et al. 2020

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“…Por otro lado, la anestesia general y bloqueos periféricos: intercostal, interpleural o paravertebral, es la asociación de una técnica de anestesia general superficial y un bloqueo sensitivo unilateral, la unión de estas dos técnicas produce una excelente analgesia intraoperatoria y postoperatoria en los casos en los que la cirugía se realiza por una toracotomía lateral (3,22,32). En una investigación de Carmona y cols, muestran que la analgesia mediante bloqueo paravertebral es una técnica aceptablemente segura en cirugía cardíaca por toracotomía, que permite una extubación precoz con un control óptimo del dolor cuando se compara con analgesia iv con opiáceos (3). La Sociedad Americana de Anestesiólogos y su Grupo de trabajo sobre manejo del dolor agudo; y Rodrigues E. S. y cols, en sus estudios consideraron a este tipo de anestesia como una opción de manejo aceptable (22,32).…”

Section: Discussionunclassified

“…Con la cirugía cardíaca mínimamente invasiva se busca reducir la incisión quirúrgica, mejorar la respuesta inflamatoria sistémica, reducir la transfusión de hemoderivados, minimizar los tiempos de estancia hospitalaria, reducir los costos del tratamiento quirúrgico, controlar del dolor postoperatorio, disminuir las complicaciones postoperatorias, permitir una rápida recuperación, además de mejorar la percepción por parte del paciente de una mejor calidad en la atención (3).…”

Section: Introductionunclassified

Anestesia en cirugía cardíaca mínimamente invasiva: Revisión narrativa.

Jiménez¹,

Reyes²,

Pena³

2019

Revista Cardiovascular

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“…Although there are advantages of very short-acting opioids, such as remifentanil, we must consider intraoperative hemodynamic deterioration and exacerbation of postoperative pain. Carmona et al reported that CPVB analgesia was an acceptable safe technique for early extubation with optimal pain control retrospectively compared with intravenous analgesia with opioids in 37 patients who underwent cardiac surgery [23]. Some authors showed that CPVB was a good pain reliever similar to EA in thoracic surgery [12–15], so we hypothesized that CPVB could potentially replace EA as the standard procedure in open-heart surgery.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Analgesia paravertebral continua frente a analgesia intravenosa en cirugía cardiaca mínimamente invasiva por minitoracotomía

Cited by 15 publications

References 24 publications

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

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

Anestesia en cirugía cardíaca mínimamente invasiva: Revisión narrativa.

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

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