Neuburger Peter J, Ngai Jennie Y, Chacon M Megan, Luria Brent, Manrique-Espinel Ana Maria, Kline Richard P, Grossi Eugene A, Loulmet Didier F
Department of Anesthesiology.
Department of Anesthesiology.
J Cardiothorac Vasc Anesth. 2015 Aug;29(4):930-6. doi: 10.1053/j.jvca.2014.10.010. Epub 2015 Jan 23.
The aim of this study was to evaluate the addition of paravertebral blockade to general anesthesia in patients undergoing robotic mitral valve repair.
A randomized, prospective trial.
A single tertiary referral academic medical center.
60 patients undergoing robotic mitral valve surgery.
Patients were randomized to receive 4-level paravertebral blockade with 0.5% bupivicaine before induction of general anesthesia. All patients were given a fentanyl patient-controlled analgesia upon arrival to the intensive care unit, and visual analog scale pain scores were queried for 24 hours. On postoperative day 2, patients were given an anesthesia satisfaction survey.
After obtaining institutional review board approval, surgical and anesthetic data were recorded perioperatively and compared between groups. Compared to general anesthesia alone, patients receiving paravertebral blockade and general anesthesia reported significantly less postoperative pain and required fewer narcotics intraoperatively and postoperatively. Patients receiving paravertebral blockade also reported significantly higher satisfaction with anesthesia. Successful extubation in the operating room at the conclusion of surgery was 90% and similar in both groups. Hospital length of stay also was similar. No adverse reactions were reported.
The addition of paravertebral blockade to general anesthesia appears safe and can reduce postoperative pain and narcotic usage in patients undergoing minimally invasive cardiac surgery. These findings were similar to previous studies of patients undergoing thoracic procedures. Paravertebral blockade alone likely does not reduce hospital length of stay. This may be more closely related to early extubation, which is possible with or without paravertebral blockade.
本研究旨在评估在接受机器人二尖瓣修复术的患者中，在全身麻醉基础上加用椎旁阻滞的效果。
一项随机前瞻性试验。
一家单一的三级转诊学术医疗中心。
60例接受机器人二尖瓣手术的患者。
患者被随机分配在全身麻醉诱导前接受0.5%布比卡因的四级椎旁阻滞。所有患者在进入重症监护病房后均给予芬太尼患者自控镇痛，并询问24小时的视觉模拟评分疼痛分数。术后第2天，对患者进行麻醉满意度调查。
获得机构审查委员会批准后，在围手术期记录手术和麻醉数据并在组间进行比较。与单纯全身麻醉相比，接受椎旁阻滞和全身麻醉的患者术后疼痛明显减轻，术中及术后所需的麻醉药物更少。接受椎旁阻滞的患者对麻醉的满意度也明显更高。手术结束时在手术室成功拔管的比例为90%，两组相似。住院时间也相似。未报告不良反应。
在全身麻醉基础上加用椎旁阻滞似乎是安全的，并且可以减轻接受微创心脏手术患者的术后疼痛和减少麻醉药物的使用。这些发现与先前对接受胸部手术患者的研究相似。单独使用椎旁阻滞可能不会缩短住院时间。这可能与早期拔管关系更为密切，无论是否使用椎旁阻滞都有可能实现早期拔管。
