Ultrasound-guided thoracic wall nerve blocks in cardiac surgery: is the best yet to come?

Capuano, Paolo; Toscano, Antonio; Rinaldi, Mauro; Brazzi, Luca

doi:10.23736/s0375-9393.20.15105-8

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Despite the growing evidence suggesting the use of opioid-free and opioid-sparing techniques, the optimal management to apply in the specific context of cardiac surgery is undetermined yet. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study

et al. 2022

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Aims: Chest wall blocks are effective alternatives for postoperative pain control in mitral valve surgery in right mini-thoracotomy (mini-MVS). We compared the efficacy of Serratus Anterior plane block (SAPB) and Erector Spinae plane block (ESPB) on postoperative pain relief after mini-MVS. Settings and Design: It is a prospective, observational study. Material and Methods: A total of 85 consecutive patients undergoing continuous SAPB and continuous ESPB for mini-MVS from March 2019 to October 2020 were included. The primary outcome was the assessment of postoperative pain evaluated as absolute value of NRS at 12, 24 and 48 h. Secondary outcomes were assessment of salvage analgesia (both opioids and NSAIDs), incidence of mild adverse effects (i.e. nausea, vomiting, and incorrect catheter placement) and timing of postoperative course (ICU and hospital length of stay, duration of mechanical ventilation, ventilator-free days). Results: The median NRS was 0.00 (0.00–3.00) at 12 h and 0.00 (0.00–2.00) at 24 and 48 h. No significant differences were observed between groups. Postoperative morphine consumption in the first 24 h was similar in both groups ( P = 0.76), whereas between 24 and 48 h was significantly less in the ESPB group compared with SAPB group, P = 0.013. NSAIDs median consumption and Metoclopramide consumption were significantly lower in the ESPB group compared to SAPB group ( P = 0.002 and P = 0.048, respectively). Conclusions: ESPB, even more than SAPB, appears to be a feasible and effective strategy for the management of postoperative pain, allowing good quality analgesia with low consumption of opioids, NSAIDs and antiemetic drugs.

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Section: Discussionmentioning

confidence: 99%

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study

et al. 2022

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“…Although there is evidence to support a multimodal and safe approach based on regional nerve blocks (3,4) , confirmations of the efficacy of PIRS block are still lacking. Cibelli et al (5) first described the effectiveness of PIRS block in intubated patient undergoing coronary artery bypass grafting, providing analgesia for sternotomy and surgical sites of chest drains, by effectively covering the T1-T10 dermatomes.…”

Section: Discussionmentioning

confidence: 99%

“…Drugs commonly used to treat moderate to severe pain are opioids that have multiple side effects, such as nausea and vomiting, ileus, respiratory depression, and sedation. A multimodal opioid-sparing analgesia strategy (2) and the use of locoregional anesthesia techniques (3) have been therefore suggested.…”

Section: Introductionmentioning

confidence: 99%

Awake cardiac surgery using the novel Pectoralis-Intercostal-Rectus Sheath (PIRS) Plane Block and Subxiphoid approach

Toscano

Balzani

Capuano

et al. 2022

Preprint

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BACKGROUND Postoperative pain after cardiac surgery is a very important issue and affects recovery, risk of postoperative complications and quality of life. The pain management has been traditionally based on intravenous opioids with growing evidence suggesting the use of opioid-free and opioid-sparing techniques to reduce its adverse effects. CASE PRESENTATION We report the case of a 75-years-old frail patient underwent awake mediastinal revision with subxiphoid access due to deep sternal wound infection using a Pectoralis-Intercostal Rectus Sheath (PIRS) plane block. During the procedure the patient never reported pain receiving acetaminophen 1 g every 8 hours for postoperative pain management without others pain relievers. CONCLUSION Ultrasound guided PIRS block could be an effective and safe analgesic technique to manage sternal and subxiphoid drainage pain in patients undergoing cardiac surgery via subxiphoid approach.

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“…After the position of the needle tip was confirmed, 10 ml of Ropivacaine 0.75% was administered; the same procedure was performed on the other side (Figure 1B). Although there is evidence to support a multimodal and safe approach based on regional nerve blocks, 3,4 confirmations of the efficacy of PIRS block are still lacking. Cibelli et al 5 first described the effectiveness of PIRS block in intubated patient undergoing coronary artery bypass grafting, providing analgesia for sternotomy and surgical sites of chest drains, by effectively covering the T1-T10 dermatomes.…”

Section: Pirs-techniquementioning

confidence: 99%

“…1 Drugs commonly used to treat moderate to severe pain are opioids that have multiple side effects, such as nausea and vomiting, ileus, respiratory depression, and sedation. A multimodal opioid-sparing analgesia strategy 2 and the use of locoregional anesthesia techniques 3 have been therefore suggested.…”

Section: Introductionmentioning

confidence: 99%

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

Toscano

Balzani

Capuano

et al. 2022

Journal of Cardiac Surgery

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Background: Postoperative pain after cardiac surgery is a very important issue and affects recovery, risk of postoperative complications and quality of life. The pain management has been traditionally based on intravenous opioids with growing evidence suggesting the use of opioid-free and opioid-sparing techniques to reduce its adverse effects.Case Presentation: We report the case of a 75-year-old frail patient underwent awake mediastinal revision with subxiphoid access due to deep sternal wound infection using a pectoralis-intercostal rectus sheath (PIRS) plane block. During the procedure the patient never reported pain receiving acetaminophen 1 g every 8 h for postoperative pain management without others pain relievers. Conclusion:Ultrasound guided PIRS block could be an effective and safe analgesic technique to manage sternal and subxiphoid drainage pain in patients undergoing cardiac surgery via subxiphoid approach.

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Ultrasound-guided thoracic wall nerve blocks in cardiac surgery: is the best yet to come?

Cited by 5 publications

References 5 publications

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study

Is continuous Erector Spinae Plane Block (ESPB) better than continuous Serratus Anterior Plane Block (SAPB) for mitral valve surgery via mini-thoracotomy? Results from a prospective observational study

Awake cardiac surgery using the novel Pectoralis-Intercostal-Rectus Sheath (PIRS) Plane Block and Subxiphoid approach

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

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