Thoracic Interfascial Plane Blocks and Outcomes After Minithoracotomy for Valve Surgery

Abstract

Introduction. Thoracic interfascial plane blocks are increasingly used for pain management after minimally invasive thoracotomy for valve repair and replacement procedures. We hypothesized that the addition of these blocks to the intercostal nerve block injected by the surgeon would further reduce pain scores and opioid utilization. Methods. In this retrospective cohort study, 400 consecutive patients who underwent minimally invasive thoracotomy for mitral or aortic valve replacement and were extubated within 2 hours of surgery were enrolled. The maximum pain score and opioid utilization on the day of surgery and other outcome variables were compared between patients who received interfascial plane blocks and those who did not. Results.193 (48%) received at least one interfascial plane block while 207 (52%) received no interfascial plane block. Patients who received a thoracic interfascial plane block had a maximum VAS score on the day of surgery (mean 7.4 ± 2.5) after the block was administered which was significantly lower than patients in the control group who did not receive the block (mean 7.9 ± 2.2) ( P = .02). Opioid consumption in the interfascial plane block group on the day of surgery was not significantly different from the control group. Conclusion. Compared to intercostal blocks alone, the addition of thoracic interfascial plane blocks was associated with a modest reduction in maximum VAS score on the day of surgery. However, no difference in opioid consumption was noted. Patients who received interfascial plane blocks also had decreased blood transfusion requirements and a shorter hospital length of stay.

Length of Hospital Stay as a Performance Metric—Is That a Fair Assessment?

“…9 In the second Original Research article, Cheruku et al studied the outcomes of thoracic interfascial plane blocks after mini-thoracotomy for valve surgery. 10 In a single center, single surgeon retrospective study, 400 consecutive patients who underwent minimally invasive mitral or aortic surgery, and were extubated within 2 hours of the procedure, were included. Forty-eight percent (193 patients) received an interfascial block, while 52% (207 patients) did not.…”