Analgesic effects of thoracic fascial plane blocks in postoperative pain management following cardiac surgery with sternotomy: a retrospective study
Öz
Aims: Acute poststernotomy pain is very severe and causes adverse hemodynamic disturbances. Various thoracic fascial plane blocks are used in the management of this pain. This study aimed to compare the analgesic effects of conventional analgesic methods and thoracic fascial plane blocks in the treatment of post-sternotomy pain.
Methods: Patients aged over than 18 years and with American Society of Anesthesiologists (ASA) physical status I-II-III who underwent elective cardiac surgery with sternotomy in 2022-2023 were included in this retrospective study. Patient records were categorized into groups based on the regional analgesia preferences applied. The groups are as follows: Group I: Patients without any blocks. Group II: Patients who received parasternal block (PSB). Group III: Patients who received serratus anterior plane block (SAPB). Group IV: Patients who received erector spinae plane block (ESPB). Then, the patients’ demographic data, laboratory data, Behavioral Pain Score (BPS) values, Visual Analog Scale (VAS) values, and additional analgesia needs were recorded and compared.
Results: The files of 128 patients were included in the study. The patients are statistically similar in terms of demographic data and surgical characteristics. Remifentanil consumption, BPS values, VAS values, and the need for additional analgesia were statistically lower in the groups in which thoracic fascial plane blocks were applied compared to the group in which conventional analgesia was applied.
Conclusion: As a result, thoracic fascial plane blocks, which have been used increasingly frequently in recent years, can provide more effective analgesia than conventional analgesia methods in cardiac surgery. Additionally, considering enhanced recovery after surgery protocols, these blocks may reduce undesirable side effects by limiting the need for opioids in the perioperative period. Since PSB and SAPB can be applied in the supine position, they may be more advantageous than ESPB in terms of ease of application.
Anahtar Kelimeler
Acute pain cardiac surgery erector spinae plane block parasternal block serratus anterior plane block thoracic fascial plane blocks
Etik Beyan
The trial was conducted after obtaining approval from the Ankara City Hospital Ethical Committee (Date: 13.12.2023, Decision No: E.Kurul-E1-23-4389)
Destekleyen Kurum
None
Teşekkür
None
Kaynakça
- Kar P, Ramachandran G. Pain relief following sternotomy in conventional cardiac surgery: a review of non neuraxial regional nerve blocks. Ann Card Anaesth. 2020;23(2):200-208.
- Sudin A, Chong C, Hassan R. Incidence and factors associated with post-sternotomy pain syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2023:38(2):466-474.
- Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-627.
- Zengin M, Ülger R, Baldemir R, Sazak H, Aydoğdu K, Alagöz A. Comparison of the effects of ultrasound-guided thoracic paravertebral block and erector spinae plane block on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic surgery. J Health Sci Med. 2022;5(6):1600-1605.
- Zengin M, Sazak H, Baldemir R, et al. Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial. BMC Anesthesiol. 2023;23(1):42.
- He Y, Xu M, Li Z, Deng L, Kang Y, Zuo Y. Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial. Anaesth Crit Care Pain Med. 2023;42(6):101268.
- Aykut A, Salman N, Demir ZA. Ultrasound-guided superficial serratus anterior plane block for cardiac surgery with median sternotomy: a retrospective study. JARSS. 2023;31(2):150-156.
- Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The effect of erector spinae plane block and combined deep and superficial serratus anterior plane block on acute pain after video-assisted thoracoscopic surgery: a randomized controlled study. J Cardiothorac Vasc Anesth. 2022;36(8):2991-2999.
- Zengin M, Baldemir R, Ülger G, Sazak H, Alagöz A. Comparison of deep and combined serratus anterior plane block after video-assisted thoracoscopic surgery; a prospective randomized trial. J Health Sci Med. 2023;6(1):18-24.
- Lee CY, Robinson DA, Johnson CA Jr, et al. A randomized controlled trial of liposomal bupivacaine parasternal ıntercostal block for sternotomy. Ann Thorac Surg. 2019;107(1):128-134.
- Sepolvere G, Fusco P, Tedesco M, Scimia P. Bilateral ultrasound-guided parasternal block for postoperative analgesia in cardiac surgery: could it be the safest strategy? Reg Anesth Pain Med. 2020;45(4):316-317.
- Gregory AJ, Grant MC, Manning MW, et al. Enhanced recovery after cardiac surgery (ERAS Cardiac) recommendations: an important first step-but there is much work to be done. J Cardiothorac Vasc Anesth. 2020;34(1):39-47.
- Magoon R, Kaushal B, Chauhan S, Bhoi D, Bisoi AK, Khan MA. A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth. 2020;64(12):1018-1024.
- Baxter R, Squiers J, Conner W, et al. Enhanced recovery after surgery: a narrative review of its application in cardiac surgery. Ann Thorac Surg. 2020;109(6):1937-1944.
- Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg. 2018;54(3):491-497.
- Balan C, Bubenek-Turconi SI, Tomescu DR, Valeanu L. Ultrasound-guided regional anesthesia-current strategies for enhanced recovery after cardiac surgery. Medicina. 2021;57(4):312.
- Lu SY, Lai Y, Dalia AA. Implementing a cardiac enhanced recovery after surgery protocol: nuts and bolts. J Cardiothorac Vasc Anesth. 2020;34(11):3104-3112.
- Zengin M, Alagöz A, Sazak H, Ülger G, Baldemir R, Şentürk M. Comparison of efficacy of erector spinae plane block, thoracic paravertebral block, and erector spinae plane block and thoracic paravertebral block combination for acute pain after video-assisted thoracoscopic surgery: a randomized controlled study. Minerva Anestesiol. 2023;89(3):138-148.
- Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Regional analgesia for cardiac surgery part 1. current status of neuraxial and paravertebral blocks for adult cardiac surgery. Semin Cardiothorac Vasc Anesth. 2021;25(4):252-264.
- Toscano A, Capuano P, Costamagna A, et al. The serratus anterior plane study: continuous deep serratus anterior plane block for mitral valve surgery performed in right minithoracotomy. J Cardiothorac Vasc Anesth. 2020;34(11):2975-2982.
- Zengin EN, Sazak H, Şekerci S, Zengin M, Yiğit H, Alagöz A. Effect of preoperative and postoperative erector spinae plane block on perioperative hemodynamics and postoperative analgesia in video-assisted thoracoscopic surgery: a randomized controlled study. J Cardio-Vasc-Thoracic Anaesth Intens Care Soc. 2023;29(2):80-87.
- Andersen LW. Lactate elevation during and after major cardiac surgery in adults: a review of etiology, prognostic value, and management. Anesth Analg. 2017;125(3):743-752.
- Naguib AN, Tobias JD, Hall MW, et al. The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study. Pediatr Crit Care Med. 2013;14(5):481-490.
- Bozkurt H, Arac D, Cigdem B. Effect of preoperative uric acid level and neutrophil/lymphocyte ratio on preoperative and postoperative visual analogue pain scores in patients with lumbar disc herniation: a cross-sectional study. Turk Neurosurg. 2019;29(5):705-709.
- Ülger G, Baldemir R, Zengin M, Sazak H, Alagöz A. Is there a correlation between preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios and postoperative pain in video-assisted thoracoscopic surgery? Medicine. 2022;101(21):e29472.
- Kölükçü V, Kahveci M. Predictive role of neutrophil/lymphocyte ratio for postoperative pain. Gaziosmanpaşa Üniv Tıp Fak Derg. 2022;14(2):110-117.
Öz
Kaynakça
- Kar P, Ramachandran G. Pain relief following sternotomy in conventional cardiac surgery: a review of non neuraxial regional nerve blocks. Ann Card Anaesth. 2020;23(2):200-208.
- Sudin A, Chong C, Hassan R. Incidence and factors associated with post-sternotomy pain syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2023:38(2):466-474.
- Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-627.
- Zengin M, Ülger R, Baldemir R, Sazak H, Aydoğdu K, Alagöz A. Comparison of the effects of ultrasound-guided thoracic paravertebral block and erector spinae plane block on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic surgery. J Health Sci Med. 2022;5(6):1600-1605.
- Zengin M, Sazak H, Baldemir R, et al. Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial. BMC Anesthesiol. 2023;23(1):42.
- He Y, Xu M, Li Z, Deng L, Kang Y, Zuo Y. Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial. Anaesth Crit Care Pain Med. 2023;42(6):101268.
- Aykut A, Salman N, Demir ZA. Ultrasound-guided superficial serratus anterior plane block for cardiac surgery with median sternotomy: a retrospective study. JARSS. 2023;31(2):150-156.
- Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The effect of erector spinae plane block and combined deep and superficial serratus anterior plane block on acute pain after video-assisted thoracoscopic surgery: a randomized controlled study. J Cardiothorac Vasc Anesth. 2022;36(8):2991-2999.
- Zengin M, Baldemir R, Ülger G, Sazak H, Alagöz A. Comparison of deep and combined serratus anterior plane block after video-assisted thoracoscopic surgery; a prospective randomized trial. J Health Sci Med. 2023;6(1):18-24.
- Lee CY, Robinson DA, Johnson CA Jr, et al. A randomized controlled trial of liposomal bupivacaine parasternal ıntercostal block for sternotomy. Ann Thorac Surg. 2019;107(1):128-134.
- Sepolvere G, Fusco P, Tedesco M, Scimia P. Bilateral ultrasound-guided parasternal block for postoperative analgesia in cardiac surgery: could it be the safest strategy? Reg Anesth Pain Med. 2020;45(4):316-317.
- Gregory AJ, Grant MC, Manning MW, et al. Enhanced recovery after cardiac surgery (ERAS Cardiac) recommendations: an important first step-but there is much work to be done. J Cardiothorac Vasc Anesth. 2020;34(1):39-47.
- Magoon R, Kaushal B, Chauhan S, Bhoi D, Bisoi AK, Khan MA. A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth. 2020;64(12):1018-1024.
- Baxter R, Squiers J, Conner W, et al. Enhanced recovery after surgery: a narrative review of its application in cardiac surgery. Ann Thorac Surg. 2020;109(6):1937-1944.
- Li M, Zhang J, Gan TJ, et al. Enhanced recovery after surgery pathway for patients undergoing cardiac surgery: a randomized clinical trial. Eur J Cardiothorac Surg. 2018;54(3):491-497.
- Balan C, Bubenek-Turconi SI, Tomescu DR, Valeanu L. Ultrasound-guided regional anesthesia-current strategies for enhanced recovery after cardiac surgery. Medicina. 2021;57(4):312.
- Lu SY, Lai Y, Dalia AA. Implementing a cardiac enhanced recovery after surgery protocol: nuts and bolts. J Cardiothorac Vasc Anesth. 2020;34(11):3104-3112.
- Zengin M, Alagöz A, Sazak H, Ülger G, Baldemir R, Şentürk M. Comparison of efficacy of erector spinae plane block, thoracic paravertebral block, and erector spinae plane block and thoracic paravertebral block combination for acute pain after video-assisted thoracoscopic surgery: a randomized controlled study. Minerva Anestesiol. 2023;89(3):138-148.
- Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Regional analgesia for cardiac surgery part 1. current status of neuraxial and paravertebral blocks for adult cardiac surgery. Semin Cardiothorac Vasc Anesth. 2021;25(4):252-264.
- Toscano A, Capuano P, Costamagna A, et al. The serratus anterior plane study: continuous deep serratus anterior plane block for mitral valve surgery performed in right minithoracotomy. J Cardiothorac Vasc Anesth. 2020;34(11):2975-2982.
- Zengin EN, Sazak H, Şekerci S, Zengin M, Yiğit H, Alagöz A. Effect of preoperative and postoperative erector spinae plane block on perioperative hemodynamics and postoperative analgesia in video-assisted thoracoscopic surgery: a randomized controlled study. J Cardio-Vasc-Thoracic Anaesth Intens Care Soc. 2023;29(2):80-87.
- Andersen LW. Lactate elevation during and after major cardiac surgery in adults: a review of etiology, prognostic value, and management. Anesth Analg. 2017;125(3):743-752.
- Naguib AN, Tobias JD, Hall MW, et al. The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study. Pediatr Crit Care Med. 2013;14(5):481-490.
- Bozkurt H, Arac D, Cigdem B. Effect of preoperative uric acid level and neutrophil/lymphocyte ratio on preoperative and postoperative visual analogue pain scores in patients with lumbar disc herniation: a cross-sectional study. Turk Neurosurg. 2019;29(5):705-709.
- Ülger G, Baldemir R, Zengin M, Sazak H, Alagöz A. Is there a correlation between preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-monocyte ratios and postoperative pain in video-assisted thoracoscopic surgery? Medicine. 2022;101(21):e29472.
- Kölükçü V, Kahveci M. Predictive role of neutrophil/lymphocyte ratio for postoperative pain. Gaziosmanpaşa Üniv Tıp Fak Derg. 2022;14(2):110-117.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Research Articles |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Mart 2024 |
| Gönderilme Tarihi | 16 Ocak 2024 |
| Kabul Tarihi | 3 Şubat 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 6 Sayı: 2 |
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