Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery.

Abstract

A b s t r a c tIntroduction: Working on the institutional Enhanced Recovery After Surgery (ERAS Cardio) protocol for off-pump coronary artery bypass graft surgery (OP-CABG) we have noticed that patients treated according to the modified anesthesia protocol had not only significantly shorter time of respiratory support and intensive care unit stay but also lower postoperative troponin T concentration than patients who had standard fentanyl/sevoflurane-based anesthesia. Aim: To compare the perioperative course of patients undergoing OP-CABG surgery and receiving standard fentanyl/ sevoflurane anesthesia and those anesthetized according to the institutional ERAS Cardio protocol with remifentanil, sevoflurane, and bilateral extensor spinae plane (ESP) block. Material and methods: Design: a prospective, open-label, observational study performed in a tertiary health center. Participants: 30 consecutive patients undergoing off-pump coronary bypass graft surgery. Interventions: 15 patients had standard anesthesia with etomidate, fentanyl, and rocuronium for induction and fentanyl/sevoflurane for maintenance (standard group); 15 others had bilateral single shot ESP block, then etomidate, remifentanil and rocuronium for induction, and remifentanil/sevoflurane for maintenance of anesthesia. Results: Median time to extubation was 7.6 (5.5-12.5) h and 1.7 (1-3.25) h in "standard care" and ERAS groups, respectively (p = 0.00002). Length of stay in the intensive care unit was also shorter for patients in the h (p = 0.00001). Troponin concentration increased to a lesser extent in patients from the ERAS group: an increase of 151.8 (71.9-174.3) ng/ml vs. 253.8 (126.6-373.1) ng/ml, p = 0.008. Conclusions: Remifentanil/sevoflurane anesthesia combined with bilateral ESP block shortens mechanical ventilation time and ICU stay, and decreases postoperative troponin-T concentration in patients undergoing off-pump coronary bypass graft surgery.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol in off-pump coronary artery bypass graft surgery. A prospective cohort feasibility study

“…Thus, fluctuations in heart rate and blood pressure are reduced in patients on remifentanil during the surgery. The present data confirm our previous results, suggesting possible cardioprotection provided by the combined regional/remifentanil anesthesia [14]. It appears that most of the relevant postoperative problems in the standard care group might be entailed by prolonged mechanical ventilation and sedation.…”

“…The postoperative drainage time was significantly shorter in the ERAS group. Thoracic drains were removed after 12 (11)(12)(13)(14)(15)(16)(17) h in the ERAS group and 23 (19)(20)(21)(22)(23)(24)(25)(26)(27) h (P = 0.00001) in the standard care (Figure 1).…”

[Retracted] Impacts of Ultrasound‐Guided Nerve Block Combined with General Anesthesia with Laryngeal Mask on the Patients with Lower Extremity Fractures

“…It can reduce perioperative stress reaction of patients, shorten hospital stay, and decrease the incidence of postoperative complications and mortality, thus accelerating postoperative recovery of patients [ 14 , 15 ]. On the basis of the concept of ERAS, combined anesthesia has been widely applied to a variety of surgeries, such as off-pump coronary artery bypass graft surgery [ 16 ] and hip replacement surgery [ 17 ]. It is well established that ultrasound-guided nerve block combined with additional intravenous anesthetic drugs contribute to improvement of the anesthetic effect in intertrochanteric fracture [ 18 ] and unilateral rib fracture [ 19 ].…”

Erector spinae plane block as perioperative analgesia for midline sternotomy in cardiac surgery: A systematic review and meta‐analysis

“…ESPB with continuous bupivacaine infusion post‐extubation 17 was associated with lower VAS scores at 12‐h postextubation compared to other studies 15,16,18,19 in our meta‐analysis and significantly decreased analgesic use, pain scores, and reduced time‐to‐extubation and ICU‐LOS. Exclusion of this study did not produce a difference in results.…”