Regional Analgesia For MICS
Shinji Ogawa, Yoshiharu Mori, Yosuke Nakai, Toshiyuki Yamada, Hisao Suda, Akira Mishima.
Nagoya City University, Nagoya, Japan.
Background: Minimally invasive cardiac surgery (MICS), via mini thoracotomy, was introduced in July 2019 into our institute. MICS is expected to be a fast track to extubation and recovery after surgery. To achieve this, adequate pain management is essential in decreasing opioid usage. Regional anesthesia has the ability to provide these goals. Based on the hypothesis that continuous paravertebral block (CPVB), a less invasive regional anesthetic technique, is safe and effective in open-heart surgery, we applied CPVB to MICS with thoracotomy. Methods: We collected demographic and clinical data of 5 adult patients who had undergone elective MICS with lateral thoracotomy between July 2019 and December 2019. All patients were well informed on the procedure, and consent for CPVB was obtained prior to surgery. Ultrasound-guided CPVB was performed after surgery in the lateral decubitus position. We performed bolus infusion of 20 mL ropivacaine 0.2% followed by continuous infusion of 4-6 mL/h of ropivacaine 0.2%. We confirmed by ultrasound that local anesthetic infused via the catheter spread in paravertebral space successfully in all patients. Results: We had excluded one patient from CPVB because of a platelet decrease. No patients required postoperative continuous intravenous infusion of opioids during CPVB. There were no cases of CPVB-related complications or postextubation respiratory failure. All patients need only acetaminophen for other analgesic use. Conclusions: CPVB is effective and safe even in MICS. It leads to reduction of other analgesic medicine use.
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