BACKGROUND: Despite the successful development of cardio-anesthesiology, no consensus exists on the preferred anesthesia method for coronary artery bypass grafting. OBJECTIVE: To evaluate the effectiveness of perioperative analgesia in minimally invasive coronary artery bypass surgery (MIDCAB) using ultrasound-assisted blockade in erector spinae plane (ESP). MATERIALS AND METHODS: A prospective, two-center, randomized study included 37 patients who underwent MIDCAB surgery. In group 1, before the induction of general anesthesia, an ESP block was performed; in group 2, the operation was performed only under general anesthesia. RESULTS: The consumption of fentanyl for anesthesia differed in groups 1 (ESP block) and 2 (general anesthesia): 0.9 (0.8; 1.0) mg vs 3.0 (2.6; 3.2) mg (p 0.01). The norepinephrine dosage was higher in group 2 than in group 1: 0.18 (0.16; 0.22) mcg/kg/min vs 0.05 (0.04; 0.06) mcg/kg/min (p 0.01). Postoperatively, the pain score was lower in group 1 than in group 2, and no additional opioids were required during the first 34 h after extubation. Thereafter, no differences in pain scores were observed between the groups. CONCLUSION: The use of an ESP block with a single injection of a local anesthetic is effective in reducing the total dosage of fentanyl used during surgery, dosage of norepinephrine, and mechanical ventilation and improve the quality of postoperative analgesia during MIDCAB.

BACKGROUND: No consensus has been established on the role of epidural anesthesia in relation to the prevention of chronic post-thoracotomic pain during minimally invasive coronary bypass surgery. OBJECTIVE: This study aimed to evaluate the effect of epidural anesthesia on the incidence of chronic post-thoracotomic pain syndrome after minimally invasive direct coronary artery bypass (MIDCAB) surgery. MATERIALS AND METHODS: The study included 87 patients who underwent MIDCAB surgery. In group 1, epidural anesthesia was performed before the induction of general anesthesia; in group 2, the operation was performed only under general anesthesia. RESULTS: The use of fentanyl for anesthesia varied: 0.5 (0.5; 0.6) mg in group 1 versus 3.5 (3.3; 3.6) mg in group 2 (p 0.01). The incidence of chronic post-thoracotomic pain in patients 3 months after surgery was higher in group 2 than in group 1 (39.1% vs 17.2%, p=0.005). The severity of pain at rest was 3 points (2; 3) in group 1 and 3 points (3; 3.5) in group 2 (p=0.018); however, during a deep breath, these differences became insignificant: 4 points (4; 4) in group 1 and 4 (4; 5) points in group 2 (p=0.453). At 6 months after surgery, chronic post-thoracotomic pain was present in 15.6% of the patients in group 1 and 34.8% in group 2 (p=0.011). After 6 months, the severity of pain at rest was 2.5 (2; 3) in group 1 and 3 (3; 3.75) in group 2 (p=0.01). No differences in cough were found: 4 (3.75; 4) points in group 1 and 4 (4; 4.5) points in group 2 (p 0.05). CONCLUSION: The use of epidural anesthesia led to a decrease in the incidence of chronic post-thoracotomic pain in patients undergoing MIDCAB surgery.

The objective of the study was to evaluate the effectiveness of prolonged ESP-block in comparison with prolonged thoracic epidural anesthesia in MIDCAB surgery.   Materials and methods. We conducted a prospective randomised two centre study with 45 patients who underwent MIDCAB surgery. In addition to general anesthesia, prolonged ESP-block was performed in group 1 (n = 22), and prolonged epidural anesthesia was performed in group 2 (n = 23).   Results. The decrease in blood pressure caused by the development of the regional block at all stages of anesthesia was more pronounced when using epidural anesthesia. In group 2, the dosage of norepinephrine was higher: 0.06 (0.05; 0.0725) mcg/kg–1/min–1 in group 1 and 0.16 (0.16; 0.16) mcg/kg/min in group 2, p < 0.001. The duration of prolonged mechanical ventilation in group 1 was lower and amounted to 102.5 (90; 110) minutes versus 110 (110; 115) minutes in group 2. The duration of surgery did not differ between the groups, the fentanyl consumption for anesthesia was higher in group 1: 0.7 (0.6; 0.8) mg versus 0.6 (0.5; 0.1) mg in group 2 (p < 0.001). Postoperatively, pain was rated as mild to moderate in both groups, with less pain in the group with epidural analgesia at stages 4 to 32 hours at rest and on coughing. After 48 hours, there were no statistical differences between the groups. The score of pain during coughing in both groups did not exceed 3 points, and patients did not need emergency analgesia.   Conclusion. In MIDCAB operations, the prolonged ESP-block is an effective method of regional anesthesia. While providing a sufficiently high level of analgesia, the use of the ESP-block during surgery only slightly increases the fentanyl usage. In the postoperative period, when using the ESP-block, extubation occurs earlier, and analgesia is almost as good as epidural blockade.

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This study describes two clinical cases of unexpectedly long duration of motor block after anterior sciatic nerve block. In two patients who underwent total knee replacement, the motor block reversion in the area of sciatic nerve innervation did not occur at the expected time. Ultrasound examination revealed the deposition of a local anesthetic near the sciatic nerve. In these two clinical cases, unintentionally prolonged sciatic nerve blockade was caused by combined age-related factors of reduced tissue perfusion and the vasoconstrictor properties of levobupivacaine. Subsequently, the block was successfully resolved in 3638 h without any neurological consequences.