Torre Debora Emanuela, Pirri Carmelo, Contristano Marialuisa, Behr Astrid Ursula, De Caro Raffaele, Stecco Carla
Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell'Angelo, 30174 Venice Mestre, Italy.
Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy.
Life (Basel). 2022 May 28;12(6):805. doi: 10.3390/life12060805.
This study tested the hypothesis that pectoralis II (PECS II) + serratus plane blocks would reduce opioid consumption and improve outcomes compared with standard practice in minimally invasive cardiac surgery. A retrospective and observational study was realized in the intensive care unit (ICU) setting of “ICLAS GVM, Istitituto Clinico Ligure Alta Specialità, (Rapallo, Italy)”, including adult patients who underwent right minithoracotomy for replacement/plastic aortic, mitral and tricuspid valve or atrial myxoma resection in cardiac surgery. Seventy-eight patients were extracted by the database and divided into two groups. Group 1 (41 patients) received ultrasound-guided PECS II + serratus plane blocks with Ropivacaine 0.25% 10 mL + 20 mL + 30 mL. Group 2 (37 patients) received intravenous opioids analgesia with morphine 20−25 mg/day or tramadol 200−300 mg/day. The primary outcomes were: the pain perceived: Critical-Care Pain Observation Tool (CPOT) score; the opioids consumption: mg morphine or tramadol, or µg sufentanyl administered; and mg paracetamol, toradol, tramadol or morphine administered as a rescue. The secondary outcomes were the hours of orotracheal intubation and of stay in ICU, and the number of episodes of nausea, vomiting, delayed awakening and respiratory depression. Group 1 vs. Group 2 consumed less opioids (Sufentanyl p < 0.0001; Morphine p < 0.0001), had a lower pain perceived (p = 0.002 at 6 h, p = 0.0088 at 12 h, p < 0.0001 at 24 h), need for rescue analgesia (p = 0.0005), episodes of nausea and vomiting (p = 0.0237) and intubation time and ICU stay (p = 0.0147 time of IOT, p < 0.0001 stay in ICU). Ultrasound-guided PECS II + serratus plane blocks demonstrated better than intravenous opioids analgesia in patients undergoing minimally invasive cardiac surgery.
与微创心脏手术的标准操作相比，胸小肌（PECS II）+ 锯肌平面阻滞可减少阿片类药物的使用并改善预后。在“ICLAS GVM，意大利利古里亚临床高专科研究所（拉帕洛）”的重症监护病房（ICU）环境中进行了一项回顾性观察研究，纳入了在心脏手术中接受右胸小切口进行主动脉、二尖瓣和三尖瓣置换/整形或心房黏液瘤切除的成年患者。从数据库中提取了78例患者并分为两组。第1组（41例患者）接受超声引导下的PECS II + 锯肌平面阻滞，使用0.25%罗哌卡因10 mL + 20 mL + 30 mL。第2组（37例患者）接受静脉注射阿片类药物镇痛，使用吗啡20 - 25 mg/天或曲马多200 - 300 mg/天。主要结局指标为：疼痛感受：重症监护疼痛观察工具（CPOT）评分；阿片类药物使用量：给予的吗啡或曲马多毫克数，或舒芬太尼微克数；以及作为补救措施给予的对乙酰氨基酚、托拉朵尔、曲马多或吗啡毫克数。次要结局指标为气管插管时长和ICU住院时长，以及恶心、呕吐、苏醒延迟和呼吸抑制的发作次数。第1组与第2组相比，阿片类药物使用量更少（舒芬太尼p < 0.0001；吗啡p < 0.0001），疼痛感受更低（6小时时p = 0.002，12小时时p = 0.0088，24小时时p < 0.0001），补救镇痛需求（p = 0.0005），恶心和呕吐发作次数（p = 0.0237）以及插管时间和ICU住院时间（气管插管时间p = 0.0147，ICU住院时间p < 0.0001）。在接受微创心脏手术的患者中，超声引导下的PECS II + 锯肌平面阻滞显示优于静脉注射阿片类药物镇痛。
