Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery

Yalamuri, Suraj; Klinger, Rebecca Y.; Bullock, W. Michael; Glower, Donald D.; Bottiger, Brandi; Gadsden, Jeff

doi:10.1097/aap.0000000000000661

Cited by 47 publications

(27 citation statements)

References 21 publications

(16 reference statements)

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“…We considered two regional techniques for additional analgesia: PECS and the serratus anterior block. Both methods have been described in patients who have undergone mini-thoracotomy procedures [15,17]. We chose to use PECS blocks due to our experience with this method.…”

Section: Discussionmentioning

confidence: 99%

“…The deposition of local anesthetic in a location anterior to the erector spinae muscle causes multidermatomal sensory block on the ipsilateral side [19]. PECS blocks require an injection of local anesthetic into two planes: between the pectoralis major and pectoralis minor muscles; and between the pectoralis minor and serratus anterior muscles [15]. These techniques block branches of the brachial plexus (anterior thoracic nerves).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…However, an abrupt reduction in pain intensity was observed at the 24th postoperative hour; this was clearly associated with the removal of chest drains. We hypothesized that an additional regional block, covering the area of the anterior part of the chest wall, might improve postoperative pain management [14,15].…”

Section: Introductionmentioning

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: 99%

Section: Discussionmentioning

confidence: 99%

Section: Oxycodone Consumptionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Our findings support other studies that demonstrate the efficacy of performing alternative regional nerve blocks for pain management after thoracotomy procedures. Yalamuri et al demonstrated significantly improved pain control after performing Pectoral Fascial (PECS) I and II nerve blocks using liposomal bupivacaine following a minimally invasive mitral valve repair. Similarly, Leyva et al showed that using a continuous erecter spinae plane (ESP) catheter as part of a multimodal pain management treatment plan provided effective analgesia and avoided the use of IV narcotics following minimally invasive cardiac surgery .…”

Section: Discussionmentioning

confidence: 99%

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

et al. 2019

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Background Less‐invasive techniques for left ventricular assist device (LVAD) implantation have shown promising outcomes but are associated with significant postoperative pain. We aim to investigate the use of ultrasound‐guided regional nerve blocks to improve pain management during these procedures. Methods We retrospectively reviewed patients implanted with a HeartMate 3 LVAD via complete sternal‐sparing (CSS) approach at our institution from February 2018 to July 2018. Patients were grouped based on their postoperative pain management plan—those who received a regional nerve block plus multimodal analgesia and a control group who received standard multimodal analgesia alone. Pain scores and analgesic use were recorded for all patients during the initial 72 hours postoperatively. Results Preoperative characteristics were similar between cohorts. Of the 28 patients included in the study, 15 (54%) received a postoperative regional nerve block. Patients who received a nerve block had significantly lower pain scores and required a lower dose of opioid analgesics (70.7 ± 13.9 vs 124.6 ± 19.3 morphine equivalents, P = 0.029) during the first 72 hours postoperatively. There was no difference in time to extubation, intensive care unit length of stay, or hospital length of stay. Conclusions Optimizing postoperative analgesia using a regional nerve block is associated with decreased opioid use and decreased postoperative pain after CSS LVAD implantation. Regional nerve blocks should be included as part of a protocol‐based postoperative pain management program.

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The Role of Ultrasound in the Management of Cardiac Patients

Kaye

Koress

Hall

et al. 2021

Ultrasound Fundamentals

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Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery

Cited by 47 publications

References 21 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

Regional nerve block decreases opioid use after complete sternal‐sparing left ventricular assist device implantation

The Role of Ultrasound in the Management of Cardiac Patients

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