Epidural analgesia for cardiac surgery

Svircevic, Vesna; Passier, Martijn; Nierich, Arno P.; Dijk, Diederik van; Kalkman, Cor J.; Heijden, Geert J. van der

doi:10.1002/14651858.cd006715.pub2

Cited by 38 publications

(25 citation statements)

References 60 publications

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“…Thoracic epidural analgesia (TEA) leads to a significantly decreased risk of AKI development post CABG surgery [32] . However, Svircevic et al [33] produced conflicting results suggesting the risk of TEA usage in a patient who may require full heparinisation. Nonetheless, the use of epidural analgesia in cardiac surgery has been associated with a reduction in mortality [34] .…”

Section: Epidural Anaesthesiamentioning

confidence: 99%

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

Harky¹,

Joshi²,

Gupta³

et al. 2020

Braz J Cardiovasc Surg

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Section: Epidural Anaesthesiamentioning

confidence: 99%

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

Harky¹,

Joshi²,

Gupta³

et al. 2020

Braz J Cardiovasc Surg

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“…A larger cohort study examining the use of TEA in patients undergoing cardiac surgery found a decreased need for dialysis (160). The results of these studies must be balanced by the failure of a Cochrane Database Review to show a mortality reduction in patients undergoing cardiac surgery who received TEA (161) as well as the potential risk associated with the use of TEA in a patient who may require full heparinization.…”

Section: Prevention Of Aki Nonpharmacologic Strategiesmentioning

confidence: 99%

AKI Associated with Cardiac Surgery

Thiele¹,

Isbell²,

Rosner

2015

Clinical Journal of the American Society of Nephrology

254

198

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Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short-and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.

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“…Moreover, epidural analgesia has been associated with a reduction in patient mortality, but the beneficial effect was rather low (number needed to treat (NNT) = 70). Other authors did not observe a higher risk of epidural hematoma in cardiac surgery patients than in general surgery patients [23,24]. The risk of hematoma after PVB in cardiothoracic surgery seems to be even lower [25,26].…”

Section: Discussionmentioning

confidence: 86%

Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

Borys¹,

Gawęda²,

Horeczy³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: One of the main challenges in cardiac surgery is effective postoperative analgesia. Erector spinae-plane block (ESP block) is a novel regional technique, introduced by Forero in 2016 for neuropathic chest pain, then used successfully for mastectomy. Aim: To establish the efficacy of the ESP block in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy. Material and methods: It is a prospective observational cohort study performed in a tertiary health center. In the treatment group, a single-shot ESP block was performed before anesthetic induction. General anesthesia was induced with etomidate, remifentanil, and rocuronium, and continued with sevoflurane and remifentanil. Remifentanil infusion was continued for 2 h post-operatively, then stopped, and the patient's trachea was extubated. Patient-controlled analgesia was started with oxycodone immediately. Total oxycodone consumption and pain severity on the visual analog scale during the first 24 h were analyzed. In the control group, no regional block was performed. Instead of remifentanil, fentanyl was used. Patients were extubated on the second day. Pain was treated with morphine, administered according to nurses' discretion. Pain intensity was evaluated on the numerical rating scale. Results: Nineteen patients were evaluated in the ESP and 25 in the control group. Mechanical ventilation time was shorter in the ESP group (0.6 (0.4-1.1) h) than in the control one (10 (8-17) h, p = 0.00001). Moreover, patients in the ESP group spent fewer days in the intensive care unit (1 (1-1) vs. (2 (2-2), p = 0.0001). Conclusions: The ESP block seems to be safe and efficient for pain control in patients undergoing right mini-thoracotomy for mitral and/or tricuspid valve repair.

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Epidural analgesia for cardiac surgery

Cited by 38 publications

References 60 publications

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

AKI Associated with Cardiac Surgery

Erector spinae-plane block as an analgesic alternative in patients undergoing mitral and/or tricuspid valve repair through a right mini-thoracotomy - an observational cohort study.

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