A Case Series of Continuous Paravertebral Block in Minimally Invasive Cardiac Surgery

Overview

Journal JA Clin Rep

Date 2018 Feb 20

PMID 29457089

Citations 3

Authors

Shintaro Tahara

Akito Inoue

Hajime Sakamoto

Yasuaki Tatara

Kayoko Masuda

Yoichiro Hattori

Yusaku Nozumi

Mitsumasa Miyagi

Surakshya Sigdel

Affiliations

Soon will be listed here.

Abstract

Background: Minimally invasive cardiac surgery (MICS), via minithoracotomy, is thought to be a fast track to extubation and recovery after surgery. For this, good coverage analgesia is essential. Epidural anesthesia, a standard technique for thoracic surgery, has high risk of complications, such as epidural abscess and spinal hematoma in open-heart surgery. Based on the hypothesis that continuous paravertebral block (CPVB), a less invasive regional anesthetic technique, is safe and effective in open-heart surgery, we applied CPVB to MICS with thoracotomy.

Findings: To assess whether CPVB could be used in open-heart surgery with fewer potential complications, we investigated our medical records of the 87 adult patients who underwent MICS at Akashi Medical Center, Hyogo, Japan, between March 2009 and May 2016. We collected data of CPVB-related complications, postextubation respiratory failure, duration of intubation, and other analgesic use from hospital clinical records. We observed no severe CPVB-related complications, such as hematoma, neuropathy, or abscess. PT-INR longer than 1.1 was associated with CPVB-related minor bleeding. Forty-three patients (47.4%) were extubated within 1 h after surgery, and there were no postextubation respiratory failures in any patients.

Conclusions: We observed no cases of severe CPVB-related complications or postextubation respiratory failure in any of our patients who underwent MICS. Preoperative prolongation of PT-INR was associated with CPVB-related minor bleeding.

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References

Horlocker T, Wedel D, Rowlingson J, Enneking F, Kopp S, Benzon H . Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010; 35(1):64-101. DOI: 10.1097/aap.0b013e3181c15c70. View

Dogan S, Graubitz K, Aybek T, Khan M, Kessler P, Moritz A . How safe is the port access technique in minimally invasive coronary artery bypass grafting?. Ann Thorac Surg. 2002; 74(5):1537-43; discussion 1543. DOI: 10.1016/s0003-4975(02)03947-4. View

Muehling B, Halter G, Schelzig H, Meierhenrich R, Steffen P, Sunder-Plassmann L . Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg. 2008; 34(1):174-80. DOI: 10.1016/j.ejcts.2008.04.009. View

Steinlechner B, Dworschak M, Birkenberg B, Lang T, Schiferer A, Moritz A . Low-dose remifentanil to suppress haemodynamic responses to noxious stimuli in cardiac surgery: a dose-finding study. Br J Anaesth. 2007; 98(5):598-603. DOI: 10.1093/bja/aem069. View

Woo Y, Seeburger J, Mohr F . Minimally invasive valve surgery. Semin Thorac Cardiovasc Surg. 2008; 19(4):289-98. DOI: 10.1053/j.semtcvs.2007.10.005. View

Senturk M, Ozcan P, Koknel Talu G, Kiyan E, Camci E, Ozyalcin S . The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg. 2002; 94(1):11-5, table of contents. DOI: 10.1213/00000539-200201000-00003. View

Carmona P, Llagunes J, Casanova I, Mateo E, Canovas S, Martin E . [Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy]. Rev Esp Anestesiol Reanim. 2012; 59(9):476-82. DOI: 10.1016/j.redar.2012.04.014. View

Junior A, Erdmann T, Santos T, Brunharo G, Filho C, Losso M . Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: Systematic review. Braz J Anesthesiol. 2014; 63(5):433-42. DOI: 10.1016/j.bjane.2013.10.002. View

Komatsu R, Turan A, Orhan-Sungur M, McGuire J, Radke O, Apfel C . Remifentanil for general anaesthesia: a systematic review. Anaesthesia. 2007; 62(12):1266-80. DOI: 10.1111/j.1365-2044.2007.05221.x. View

10.

Lison S, Schill M, Conzen P . Fast-track cardiac anesthesia: efficacy and safety of remifentanil versus sufentanil. J Cardiothorac Vasc Anesth. 2007; 21(1):35-40. DOI: 10.1053/j.jvca.2006.03.011. View

11.

Knapik M, Knapik P, Nadziakiewicz P, Misiolek H, Saucha W, Walaszczyk M . Comparison of remifentanil or fentanyl administration during isoflurane anesthesia for coronary artery bypass surgery. Med Sci Monit. 2006; 12(8):PI33-8. View

12.

Raveglia F, Rizzi A, Leporati A, Di Mauro P, Cioffi U, Baisi A . Analgesia in patients undergoing thoracotomy: epidural versus paravertebral technique. A randomized, double-blind, prospective study. J Thorac Cardiovasc Surg. 2013; 147(1):469-73. DOI: 10.1016/j.jtcvs.2013.09.024. View

13.

Okitsu K, Iritakenishi T, Iwasaki M, Imada T, Fujino Y . Risk of Hematoma in Patients With a Bleeding Risk Undergoing Cardiovascular Surgery With a Paravertebral Catheter. J Cardiothorac Vasc Anesth. 2016; 31(2):453-457. DOI: 10.1053/j.jvca.2016.06.002. View

14.

Richardson J, Lonnqvist P . Thoracic paravertebral block. Br J Anaesth. 1998; 81(2):230-8. DOI: 10.1093/bja/81.2.230. View

15.

Joshi G, Bonnet F, Shah R, Wilkinson R, Camu F, Fischer B . A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008; 107(3):1026-40. DOI: 10.1213/01.ane.0000333274.63501.ff. View

16.

Tryba M . [Epidural regional anesthesia and low molecular heparin: Pro]. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993; 28(3):179-81. DOI: 10.1055/s-2007-998902. View

17.

Esper S, Bottiger B, Ginsberg B, Del Rio J, Glower D, Gaca J . CASE 8--2015. Paravertebral Catheter-Based Strategy for Primary Analgesia After Minimally Invasive Cardiac Surgery. J Cardiothorac Vasc Anesth. 2015; 29(4):1071-80. DOI: 10.1053/j.jvca.2015.02.018. View

18.

Myles P, Hunt J, Fletcher H, Watts J, Bain D, Silvers A . Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg. 2002; 95(4):805-12, table of contents. DOI: 10.1097/00000539-200210000-00004. View

19.

Wildgaard K, Petersen R, Hansen H, Moller-Sorensen H, Ringsted T, Kehlet H . Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter. Eur J Cardiothorac Surg. 2012; 41(5):1072-7. DOI: 10.1093/ejcts/ezr151. View

20.

Yeung J, Gates S, Naidu B, Wilson M, Smith F . Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016; 2:CD009121. PMC: 7151756. DOI: 10.1002/14651858.CD009121.pub2. View