Fadayomi Ayòtúndé B, Boussy Christopher, Walker Jennifer, Gebhardt Brian R, Badr Rana
Pain Management Center, Saint Francis Medical Center, Cape Girardeau, MO.
Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, MA; Department of Anesthesiology, Perioperative and Pain Medicine, Lahey Hospital & Medical Center, Burlington, MA.
J Cardiothorac Vasc Anesth. 2025 Jun 22. doi: 10.1053/j.jvca.2025.06.034.
To evaluate the impact of a multimodal pain management (MPM) protocol with anterior chest wall fascial plane blocks on perioperative opioid administration and postoperative outcomes in cardiac surgery.
A single-center retrospective cohort analysis.
University hospital operating rooms and intensive care units, from January 1, 2021, to August 31, 2022.
A total of 463 adult patients undergoing elective cardiac surgery via median sternotomy.
An Enhanced Recovery After Cardiac Surgery (ERACS) MPM protocol was implemented, including preoperative acetaminophen, intraoperative dexmedetomidine infusion, and preincision anterior chest wall fascial plane blocks. Pre-ERACS (n = 247) and post-ERACS (n = 216) groups were compared.
The primary outcomes were intraoperative opioid dose and 48-hour postoperative opioid dose (morphine milligram equivalents). Secondary outcomes were total postoperative ventilation hours, incidence of postoperative atrial fibrillation (POAF), and hospital length of stay (LOS). Multivariable regression showed statistically significant reductions in intraoperative opioid dose (ß = -0.63; 95% confidence interval [CI], -0.72 to -0.54; p < 0.0001), ventilation hours (ß = -0.59; 95% CI -1.16 to -0.02; p = 0.04), LOS (ß = -0.15; 95% CI, 0.22 to -0.08; p < 0.0001), and POAF (ß = -0.46; 95% CI, -0.91 to -0.02; p = 0.04). There was no significant difference in 48-hour postoperative opioid dose between the pre-ERACS and post-ERACS groups.
The ERACS MPM with anterior chest wall blocks was associated with reductions in opioid use, ventilation hours, POAF, and LOS, suggesting improved perioperative outcomes.
评估采用前胸壁筋膜平面阻滞的多模式疼痛管理（MPM）方案对心脏手术围手术期阿片类药物使用及术后结局的影响。
单中心回顾性队列分析。
大学医院手术室和重症监护病房，时间为2021年1月1日至2022年8月31日。
共有463例接受正中开胸择期心脏手术的成年患者。
实施了心脏手术后加速康复（ERACS）MPM方案，包括术前使用对乙酰氨基酚、术中输注右美托咪定以及切开前进行前胸壁筋膜平面阻滞。比较了ERACS实施前（n = 247）和实施后（n = 216）两组。
主要结局为术中阿片类药物剂量和术后48小时阿片类药物剂量（吗啡毫克当量）。次要结局为术后总通气时长、术后房颤（POAF）发生率及住院时间（LOS）。多变量回归显示，术中阿片类药物剂量（β = -0.63；95%置信区间[CI]，-0.72至-0.54；p < 0.0001）、通气时长（β = -0.59；95% CI -1.16至-0.02；p = 0.04）、LOS（β = -0.15；95% CI，0.22至-0.08；p < 0.0001）和POAF（β = -0.46；95% CI，-0.91至-0.02；p = 0.04）均有统计学意义的降低。ERACS实施前和实施后两组术后48小时阿片类药物剂量无显著差异。
采用前胸壁阻滞的ERACS MPM与阿片类药物使用减少、通气时长缩短、POAF减少及LOS缩短相关，提示围手术期结局得到改善。
