Department of Anesthesiology, VKV American Hospital, Istanbul, Turkey.
Department of Anesthesiology and Pain Clinic, VKV American Hospital, Istanbul, Turkey.
J Cardiothorac Surg. 2022 Jul 6;17(1):170. doi: 10.1186/s13019-022-01923-6.
Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences.
This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined.
The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block.
Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.
心脏手术后的疼痛具有多灶性和多因素性。开胸、胸骨复位、内乳动脉解剖、后肋脱位或骨折、潜在的臂丛神经损伤以及纵隔和胸腔引流都可导致术后即刻疼痛。疼痛管理无效可导致全身和肺部并发症，并对心脏产生重大影响。
本研究比较了我们诊所心脏手术患者围手术期疼痛管理中区域麻醉技术的有效性。研究了不同镇痛方法对恢复的影响。
回顾性评估了 221 例接受冠状动脉旁路移植术的患者的记录。手术室拔管率为 91%。没有患者接受球囊泵支持，20 例患者在插管时转入心血管重症监护病房。这 20 例患者中有 2 例接受了区域麻醉，但其余 18 例没有。术中及术后阿片类药物消耗检查显示，接受区域麻醉的患者消耗水平明显较低。应用的区域麻醉技术中最有效的结果是双注射竖脊肌平面阻滞。
区域麻醉技术在心脏手术中严重限制了阿片类药物的消耗。在快速恢复标准方面，其重要性将逐渐增加。基于我们的研究结果，竖脊肌平面阻滞双注射似乎是心脏手术中最有效的技术。因此，我们在这些手术中倾向于使用筋膜平面阻滞。试验编号 本研究在 ClinicalTrials（NCT05282303）上注册。伦理委员会注册和批准号为 2021.464.IRB1.131。
