Ata Filiz, Yılmaz Canan
Anesthesiology and Reanimation, University of Bursa, Bursa Yüksek İhtisas Education and Research Hospital, Bursa, TUR.
Cureus. 2023 Mar 3;15(3):e35718. doi: 10.7759/cureus.35718. eCollection 2023 Mar.
Cardiac surgery typically causes moderate to severe postoperative pain and discomfort. Inadequate pain management in the early postoperative period leads to pulmonary complications. The length of intensive care unit (ICU) stay and the hospital is typically prolonged. As a component of multimodal analgesia regimens, fascial plane blocks have become more popular. In our clinic, serratus anterior plane blocks (SAPB), pectoral nerve blocks (PECS I-II), and pectointercostal nerve fascial plane blocks (PIFB) are performed by ultrasonography. We wished to evaluate the postoperative visual pain scale, initial additional analgesic agent requirement time, extubation time, morbidity and mortality in patients who underwent open heart surgery with fascial plane blocks.
Forty-eight patients over 18 years who underwent open heart surgery with sternotomy between 01 September 2021 and 15 June 2022 were evaluated retrospectively. Only patients with chest wall blocks placed at the end of surgery were included in the study. In Group 1, the PECS II block was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery in the operating room. In Group 2, SAPB was placed on the chest tube side and bilateral PIFBs were placed at the end of surgery. Data regarding patient demographics, anesthesia method applied, amount of opioid used intraoperatively, cardiopulmonary bypass time, anesthesia and surgery time, postoperative extubation time, mechanical ventilation time, Visual Analogue Scale (VAS) of patients at rest and movement at 6th, 12th, 18th, 24th, 48th hours post-extubation, time to and type of first postoperative analgesic, postoperative complications, length of cardiac intensive care unit (CICU) stay and hospital length of stay were recorded from hospital records.
The data of a total of 46 patients (Group 1: PECS II block + PIFB, n=20; Group 2: SAPB+ PIFB, n=26) were analyzed retrospectively. There was no difference in demographic variables between the groups. Intraoperative opioid usage, operation time, Cardiopulmonary bypass time, postoperative mechanical ventilation time, extubation time, ICU discharge time, and length of hospital stay were not statistically different between the groups. The first rescue analgesic requirement time was longer in group 2 than in group 1 but not statistically significant (18.76±15.36 h vs 12.62±10.61 h, p=0.162). The post-extubation VAS scores at rest and movement at the 6th hour were significantly lower in group 2 than in group 1 (1.73±1.28 vs 3.15±2.10, respectively, p=0.02).
In our study, the VAS scores at the 6th hour were lower in SAPB + PIFB group than in PECS II + PIFB group. As these blocks can be easy to apply, we thought these combinations could be an alternative for pain relief in cardiac surgery. Prospective randomized studies are needed with a large number of patients.
心脏手术通常会导致中度至重度的术后疼痛与不适。术后早期疼痛管理不当会引发肺部并发症。重症监护病房（ICU）停留时间和住院时间通常会延长。作为多模式镇痛方案的一部分，筋膜平面阻滞越来越受欢迎。在我们诊所，通过超声进行前锯肌平面阻滞（SAPB）、胸神经阻滞（PECS I-II）和胸肋神经筋膜平面阻滞（PIFB）。我们希望评估接受筋膜平面阻滞的心脏直视手术患者的术后视觉疼痛评分、首次额外使用镇痛剂的时间、拔管时间、发病率和死亡率。
回顾性评估2021年9月1日至2022年6月15日期间48例18岁以上接受胸骨切开术心脏直视手术的患者。本研究仅纳入手术结束时放置胸壁阻滞的患者。第1组在手术结束时于手术室在胸管侧放置PECS II阻滞并双侧放置PIFB。第2组在胸管侧放置SAPB并在手术结束时双侧放置PIFB。从医院记录中记录患者人口统计学数据、应用的麻醉方法、术中使用的阿片类药物量、体外循环时间、麻醉和手术时间、术后拔管时间、机械通气时间、拔管后第6、12、18、24、48小时患者静息和活动时的视觉模拟评分（VAS）、首次术后镇痛的时间和类型、术后并发症、心脏重症监护病房（CICU）停留时间和住院时间。
共对46例患者的数据（第1组：PECS II阻滞+PIFB，n = 20；第2组：SAPB+PIFB，n = 26）进行回顾性分析。两组间人口统计学变量无差异。两组间术中阿片类药物使用量、手术时间、体外循环时间、术后机械通气时间、拔管时间、ICU出院时间和住院时间无统计学差异。第2组首次使用急救镇痛剂的时间比第1组长，但无统计学意义（18.76±15.36小时对12.62±10.61小时，p = 0.162）。第2组拔管后第6小时静息和活动时的VAS评分显著低于第1组（分别为1.73±1.28对3.15±2.10，p = 0.02）。
在我们的研究中，SAPB + PIFB组第6小时的VAS评分低于PECS II + PIFB组。由于这些阻滞易于实施，我们认为这些联合方式可作为心脏手术疼痛缓解的一种选择。需要进行大量患者的前瞻性随机研究。
