Serratus anterior plane block for minimal invasive heart surgery

Abstract

BackgroundMinimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS.MethodsIt’s retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France. All patients scheduled for MIHS was included. Data was collected retrospectively. During this period, 20 patients had SAPB and 26 had CWI. SAPB was performed before extubation with a single injection of 0.5 mg/kg of ropivacaïne (5 mg/ml). In the CWI group, catheter was inserted in the subcutaneous space by the surgeon at the end of the procedure. A 10 ml bolus of ropivacaïne (7.5 mg/mL) was followed by a continuous infusion (2 mg/ml) between 7 and 12 ml/h for 48 h. Morphine consumption and visual analog score (VAS) were recorded for 48 h. Length of stay in intensive care unit and hospital was also collected.ResultsMorphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group.ConclusionSAPB appears effective in reducing postoperative MIHS pain.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0614-5) contains supplementary material, which is available to authorized users.

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

“…To date, we are not aware of any prospective study comparing the use of the serratus anterior, erector spinae, and pectoralis nerve blocks in cardiothoracic patients. Kaushal et al demonstrated evidence that SAP and PEC nerve blocks are both superior to intercostal nerve blocks in providing prolonged postoperative pain control following thoracotomy in pediatric cardiac cases, and Berthoud et al demonstrated that SAP block provided better pain management than continuous wound infiltration after minimally invasive heart surgery. Our institutional experience with the use of SAP and PEC nerve blocks in this patient population supports both studies.…”

“…While opioids have traditionally been the mainstay of postoperative pain‐control therapy, the significantly associated side effects and the rise of the national opioid epidemic has created an emphasis on treatment plans that minimize opioid use. Protocols that utilize multimodal pain therapies, such as regional nerve blocks, have shown improved perioperative pain control for a number of cardiac and thoracic procedures …”

“…Protocols that utilize multimodal pain therapies, such as regional nerve blocks, have shown improved perioperative pain control for a number of cardiac and thoracic procedures. [10][11][12][13] In this study, we aim to determine if the use of postoperative ultrasound-guided regional nerve blocks as part of the pain management regiment after CSS LVAD implantation decreases postoperative patient-reported pain scores or opioid use.…”

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

“…Further randomized studies are needed to confirm these results. 11 (20) 40 17 (31) 125 (50-263) STROBE_checklist_v4.doc…”

“…All data was extracted from our institutional database and collected by a physician who was not involved in the care of the study patients.Statistical analysisThe trial was designed to investigate the potential superiority of OFA in terms of postoperative morphine consumption. According to the studies of Berthoud et al, we calculated that 55 patients per group would be sufficient to demonstrate a 10 mg difference in morphine consumption (with a mean consumption of 18 mg) with a power of 0.8 and an alpha risk of 0.05[20,21].Based on known factors associated with postoperative pain and operative course, the database was matched (1:1) on age, body mass index, Euroscore 2, and type of surgery (sternotomy/thoracotomy) [22, 23]. Normal distribution was assessed using the Shapiro-Wilk test.…”