Use of Paravertebral Blockade to Facilitate Early Extubation after Minimally Invasive Cardiac Surgery

Lynch, James J.; Mauermann, William J.; Pulido, Juan N.; Rehfeldt, Kent H.; Torres, Norman E.

doi:10.1177/1089253210363009

Cited by 19 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rodrigues et al 63 utilized paravertebral analgesia to reduce intraoperative narcotic administration and facilitate extubation in the operating room following robotic mitral valve repair. Similar benefits on early extubation were also shown by Lynch et al 64 when they used paravertebral analgesia to provide analgesia for 14 patients undergoing minimally invasive atrial septal defect closure or mitral valve repair/replacement using a right-sided thoracoscopic approach.…”

Section: Paravertebral Analgesiasupporting

confidence: 58%

Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery

Devarajan

Balasubramanian

Nazarnia

et al. 2021

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

Cardiac surgeries are known to produce moderate to severe pain. Pain management has traditionally been based on intravenous opioids. Poorly controlled pain can result in increased incidence of respiratory complications such as atelectasis and pneumonia leading to prolonged intubation and intensive care unit length of stay and subsequent prolonged hospital stay. Adequate perioperative analgesia improves hemodynamics and immunologic responses, which would result in better outcomes after cardiac surgery. Opioid sparing “Enhanced Recovery After Surgery” protocols are increasingly being incorporated into cardiac surgeries. This will reduce opioid requirements and opioid-related side effects and facilitate fast-tracking of patients. Regional analgesia can be provided by neuraxial blocks, fascial plane blocks, peripheral nerve blocks, or simply by the infiltration of the wound with local anesthetics for cardiac surgery. Neuraxial analgesia is provided through epidural, spinal, and paravertebral routes. Though they are being replaced by peripheral fascial plane blocks, epidural and spinal analgesia are still being used in some centers. In this article, neuraxial forms of analgesia are focused. We sought to review epidural analgesia and its impact in suppressing hemodynamic stress response, reducing pulmonary complications, and development of chronic pain. The relationship between intraoperative heparinization and potential neuraxial hematoma is discussed. Other neuraxial options such as spinal and paravertebral analgesia and their usefulness, benefits, and limitations are also reviewed.

show abstract

Section: Paravertebral Analgesiasupporting

confidence: 58%

Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery

Devarajan

Balasubramanian

Nazarnia

et al. 2021

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

show abstract

“…The unilateral location of the incisions is ideal for the use of PVB for the management of postoperative pain control. Lynch et al 30 performed a retrospective study of 14 patients who underwent minimally invasive cardiac surgery using PVB and general anesthesia. Paravertebral blockade were performed to reduce opioid requirements and facilitate immediate extubation.…”

Section: Discussionmentioning

confidence: 99%

Does Paravertebral Blockade Facilitate Immediate Extubation after Totally Endoscopic Robotic Mitral Valve Repair Surgery?

Neuburger

Chacon

Luria

et al. 2015

Innovations�(Phila)

View full text Add to dashboard Cite

Objective Immediate extubation of select patients in the operating room after cardiac surgery has been shown to be safe and may result in improved hemodynamics and decreased cost perioperatively. The aim of this study was to evaluate whether the addition of paravertebral blockade (PVB) to general anesthesia facilitates extubation in the operating room in patients undergoing totally endoscopic robotic mitral valve repair (TERMR). Methods A review of 65 consecutive patients who underwent TERMR between January 2012 and June 2013 at a single institution was conducted. Patients were divided into two groups, one group that received PVB and general anesthesia and a second group that received general anesthesia alone. The data analyzed included quantities of anesthetic administered during surgery and the location of extubation after surgery. Results A total of 34 patients received PVB and general anesthesia, whereas 31 received general anesthesia alone. The two groups had similar demographic and surgical data. Patients in the PVB and general anesthesia group were more likely to be extubated in the operating room (67.6%, n = 23 vs 41.9%, n = 13, P = 0.048) and required less intraoperative fentanyl (3.41 μg/kg vs 4.90 μg/kg, P = 0.006). There were no adverse perioperative events in either group related to PVB or extubation. Conclusions The addition of PVB to general anesthesia for perioperative pain control facilitated extubation in the operating room in patients undergoing TERMR. Paravertebral blockade allowed for lower intraoperative fentanyl dosing, which may account for the increased incidence of immediate extubation. A detailed prospective study is warranted.

show abstract

“…Robotic and endoscopic cardiac surgery typically involves three access ports in the left thorax. While exact insertion sites vary, several regional techniques have been applied in this type of surgery and described by various case reports including paravertebral [15,16], pectoral (PECS) and serratus anterior [17], and transversus thoracic plane (TTP) blocks [18]. Similarly, a variety of established and novel procedures are being performed through transapical access approaches requiring mini thoracotomy.…”

Section: Minimally Invasive Cardiac Proceduresmentioning

confidence: 99%

Regional anesthesia techniques for cardiac surgery: where are we?

Kim

Gonzalez-Ciccarelli²,

Brovman³

2022

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

Purpose of reviewInadequate pain relief after cardiac surgery results in decreased patient experience and satisfaction, increased opioid consumption with its associated adverse consequences, and reduced efficiency metrics. To mitigate this, regional analgesic techniques are an increasingly important part of the perioperative cardiac anesthesia care plan. The purpose of this review is to compare current regional anesthesia techniques, and the relative evidence supporting their efficacy and safety in cardiac surgery. Recent findingsNumerous novel plane blocks have been developed in recent years, with evidence of improved pain control after cardiac surgery.

show abstract

Use of Paravertebral Blockade to Facilitate Early Extubation after Minimally Invasive Cardiac Surgery

Cited by 19 publications

References 0 publications

Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery

Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery

Does Paravertebral Blockade Facilitate Immediate Extubation after Totally Endoscopic Robotic Mitral Valve Repair Surgery?

Regional anesthesia techniques for cardiac surgery: where are we?

Contact Info

Product

Resources

About