Carmona P, Llagunes J, Casanova I, Mateo E, Cánovas S, Martín E, Marqués J I, Peña J J, de Andrés J
Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Consorcio Hospital General Universitario de Valencia, España.
Rev Esp Anestesiol Reanim. 2012 Nov;59(9):476-82. doi: 10.1016/j.redar.2012.04.014. Epub 2012 May 31.
Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy.
A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques.
A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed.
PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.
通过小切口进行的微创心脏手术旨在实现更快的恢复和更短的住院时间。为实现这一目标，疼痛控制至关重要。本研究旨在评估小切口心脏手术后镇痛的质量以及与镇痛技术相关的并发症。
对2009年至2011年间在本中心接受微创心脏手术的患者进行了一项描述性、观察性和回顾性研究。根据所接受的镇痛类型将患者分为两组：通过椎旁导管输注局部麻醉剂进行镇痛（PVB组）和静脉注射阿片类药物进行镇痛（IOA组）。本研究的目的是比较两种技术在镇痛质量、与镇痛技术相关的并发症、拔管时间、术后并发症以及住院时间方面的差异。
共有37例患者接受了改良的微创心脏Port入路手术。15例患者通过椎旁阻滞进行镇痛，另外22例接受静脉注射阿片类药物镇痛。数据以均值和标准差（SD）表示。PVB组60%的患者气管拔管时间少于4小时，而IOA组为22%（P<0.05）。PVB组在重症监护病房（ICU）的住院时间为1.2（0.7）天，而IOA组为2.2（0.7）天（P<0.05）。PVB组的平均住院时间为4.8（1.2）天，IOA组为5.6（2.8）天（P>0.05）。未观察到与持续椎旁阻滞相关的并发症。
与静脉注射阿片类药物镇痛相比，PVB镇痛是开胸心脏手术中一种可接受的安全技术，能够在实现最佳疼痛控制的同时实现早期拔管。
