Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA; Institute for Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
Department of Pharmacy, Emory University Hospital Midtown, Atlanta, GA.
J Cardiothorac Vasc Anesth. 2021 Jul;35(7):2034-2042. doi: 10.1053/j.jvca.2020.09.112. Epub 2020 Sep 20.
Regional anesthesia techniques are gaining traction in cardiac surgery. The aim of this study was to compare the analgesic efficacy of erector spinae plane block catheters (ESPBC), serratus anterior plane block catheters (SAPBC), and paravertebral single-shot block (PVB) versus no block after robotic minimally invasive direct coronary artery bypass (MIDCAB).
This was a retrospective observational study of routinely recorded data.
The study was performed at a single healthcare system.
All patients underwent robotic MIDCAB.
Data were analyzed from 346 patients during a 53-month period. The clinical data warehouse was queried for all robotic MIDCAB surgeries. Variables abstracted included type of nerve block, age, sex, use of adjuncts, Society of Thoracic Surgeons predicted short length of stay (PSLOS), total opioid consumption during the 72 hours after surgery, and postoperative hospital length of stay (LOS). The primary outcome was total oral morphine milligram equivalents (MME) consumed during the first 72 hours after surgery. The secondary outcome was hospital LOS.
In a model adjusting for PSLOS, the authors did not observe an association between ESPBC and the reduction of total administered oral MME within 72 hours after surgery. There was no significant difference in MME when comparing patients who received PVB to patients with ESPBC. Older age and female sex were associated with significantly lower MME. Patients who received ESPBC had a significantly shorter hospital LOS than patients with SAPBC.
These findings suggested that postoperative pain after MIDCAB surgery might not be completely covered by ESPBC. Prospective studies are needed to further elucidate the value of this technique for robotic MIDCAB.
区域麻醉技术在心脏手术中越来越受欢迎。本研究的目的是比较竖脊肌平面阻滞导管（ESPBC）、前锯肌平面阻滞导管（SAPBC）和椎旁单次阻滞（PVB）与机器人微创直接冠状动脉旁路移植术（MIDCAB）后无阻滞的镇痛效果。
这是一项回顾性观察性研究，对常规记录的数据进行分析。
该研究在一个单一的医疗保健系统中进行。
所有患者均接受机器人 MIDCAB 手术。
在 53 个月的时间内，对 346 名患者的数据进行了分析。从临床数据仓库中查询了所有机器人 MIDCAB 手术的数据。提取的变量包括神经阻滞类型、年龄、性别、辅助药物的使用、胸外科医生预测的短期住院时间（PSLOS）、手术后 72 小时内总阿片类药物消耗量以及术后住院时间（LOS）。主要结果是手术后 72 小时内口服吗啡毫克当量（MME）的总消耗量。次要结果是住院时间。
在调整 PSLOS 的模型中，作者没有观察到 ESPBC 与术后 72 小时内总口服 MME 减少之间存在关联。与接受 PVB 的患者相比，接受 ESPBC 的患者的 MME 没有显著差异。年龄较大和女性与 MME 显著降低相关。接受 ESPBC 的患者的住院时间明显短于接受 SAPBC 的患者。
这些发现表明，MIDCAB 手术后的术后疼痛可能无法完全被 ESPBC 覆盖。需要前瞻性研究进一步阐明该技术在机器人 MIDCAB 中的价值。
