Kumar Karthik Narendra, Kalyane Ravikumar Nagashetty, Singh Naveen G, Nagaraja P S, Krishna Madhu, Babu Balaji, Varadaraju R, Sathish N, Manjunatha N
Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Department of Cardiaothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2018 Jul-Sep;21(3):333-338. doi: 10.4103/aca.ACA_15_18.
Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique.
We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia.
Forty adult patients between the age groups of 25 and 65 years undergoing coronary artery bypass grafting or valve surgeries through midline sternotomy under general anesthesia were enrolled in the study. Patients were randomly allocated into two groups with 20 in each group. Group 1 patients did not receive Pecs block, whereas Group 2 patients received bilateral Pecs block postoperatively. Patients were extubated once they fulfilled extubation criteria. Ventilator duration was recorded. Patients were interrogated for pain by visual analog scale (VAS) scoring at rest and cough. Inspiratory flow rate was assessed using incentive spirometry.
Pecs group patients required lesser duration of ventilator support (P < 0.0001) in comparison to control group. Pain scores at rest and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were comparable between two groups. Peak inspiratory flow rates were higher in Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05). Thirty-four episodes of rescue analgesia were given in control group, whereas in Pecs group, there were only four episodes of rescue analgesia.
Pecs block is technically simple and effective technique and can be used as part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and outcome.
心脏手术患者术后良好的镇痛有助于早期康复和下床活动。胸肌神经（Pecs）阻滞可作为胃肠外、椎旁和胸段硬膜外镇痛的替代方法，这是一种新颖的、侵入性较小的区域镇痛技术。
我们假设与胃肠外镇痛相比，Pecs阻滞可为接受正中胸骨切开术的心脏手术患者提供更好的术后镇痛效果。
40例年龄在25至65岁之间、在全身麻醉下通过正中胸骨切开术进行冠状动脉搭桥术或瓣膜手术的成年患者纳入本研究。患者被随机分为两组，每组20例。第1组患者未接受Pecs阻滞，而第2组患者术后接受双侧Pecs阻滞。患者一旦符合拔管标准即进行拔管。记录机械通气时间。通过视觉模拟量表（VAS）评分在静息和咳嗽时询问患者疼痛情况。使用激励肺活量计评估吸气流量。
与对照组相比，Pecs组患者所需的机械通气支持时间更短（P < 0.0001）。拔管后0、3、6、12和18小时，Pecs组静息和咳嗽时的疼痛评分显著较低（P < 0.05）。在24小时时，两组的VAS评分相当。在0、3、6、12、18和24小时时，Pecs组的吸气峰值流速高于对照组（P < 0.05）。对照组给予34次补救性镇痛，而Pecs组仅给予4次补救性镇痛。
Pecs阻滞是一种技术简单且有效的技术，可作为心脏手术患者术后多模式镇痛的一部分，以提高患者舒适度和改善预后。
