This study tested the hypothesis that pectoralis II (PECS II) + serratus plane blocks would reduce opioid consumption and improve outcomes compared with standard practice in minimally invasive cardiac surgery. A retrospective and observational study was realized in the intensive care unit (ICU) setting of “ICLAS GVM, Istitituto Clinico Ligure Alta Specialità, (Rapallo, Italy)”, including adult patients who underwent right minithoracotomy for replacement/plastic aortic, mitral and tricuspid valve or atrial myxoma resection in cardiac surgery. Seventy-eight patients were extracted by the database and divided into two groups. Group 1 (41 patients) received ultrasound-guided PECS II + serratus plane blocks with Ropivacaine 0.25% 10 mL + 20 mL + 30 mL. Group 2 (37 patients) received intravenous opioids analgesia with morphine 20–25 mg/day or tramadol 200–300 mg/day. The primary outcomes were: the pain perceived: Critical-Care Pain Observation Tool (CPOT) score; the opioids consumption: mg morphine or tramadol, or µg sufentanyl administered; and mg paracetamol, toradol, tramadol or morphine administered as a rescue. The secondary outcomes were the hours of orotracheal intubation and of stay in ICU, and the number of episodes of nausea, vomiting, delayed awakening and respiratory depression. Group 1 vs. Group 2 consumed less opioids (Sufentanyl p < 0.0001; Morphine p < 0.0001), had a lower pain perceived (p = 0.002 at 6 h, p = 0.0088 at 12 h, p < 0.0001 at 24 h), need for rescue analgesia (p = 0.0005), episodes of nausea and vomiting (p = 0.0237) and intubation time and ICU stay (p = 0.0147 time of IOT, p < 0.0001 stay in ICU). Ultrasound-guided PECS II + serratus plane blocks demonstrated better than intravenous opioids analgesia in patients undergoing minimally invasive cardiac surgery.

With an incidence of over 1.5 million worldwide per annum, breast cancer continues to be the most common cancer affecting the female population. The main and most effective treatment in over 40% of these patients is a primary neoplasm resection. General anaesthesia, at times in association with loco-regional anaesthetics, is the most commonly used anaesthesia technique for radical mastectomies. Nausea, vomiting, and considerable postoperative pain, which are commonly experienced side effects and complications of general anaesthesia, tend, however, to augment most patients’ post-surgical morbidity. A growing body of research has shown that loco-regional anaesthesia often used together with and, in some cases, in the substitution of general anaesthesia can be a safe, effective alternative. This work is a case report regarding a 94-year-old elderly patient who was anaesthetised during a left radical mastectomy using exclusively combined interpectoral and pectoserratus plane blocks.

Background: This article shows the concrete possibility to resolve important hypotension during assistance with ECMO by doing simple maneuvers. The abdominal fluid overload and hypertension is a problem probably a little underestimated and underestimated during the post-cardiac arrest reperfusion phase. Our clinical case shows how an important intra-abdominal hypertension developed and how it was treated just a few hours after the implantation of the post refractory cardiac arrest ECMO. Case presentation We describe a case of cardiac arrest in a 47-year-old male, 80kg, with history of moderate hypertension. Cardiac arrest happened in the patient’s house, in the presence of his wife. She immediately called for aid. 1 minute after the event cardiopulmonary resuscitation (CPR) was started by a policeman (BLS performer). 20 minutes later the Emergency Medical Service (EMS) arrived. The cardiac rhythm of presentation was a ventricular fibrillation (VF). Forty minutes after the event, the EMS arrived with a declared ongoing CPR protocol at the cath-lab at Angel’s Hospital in Mestre (Venice). 50 min after the event a veno-arterial ECMO support was started. 3 hours after the admission in the ICU, we observed a sudden hemodynamic instability, characterized by hypotension, MAP < 60 mmHg, increase in lactates, drastic decrease in ECMO blood flow (1,5-1,8 lpm) despite > 3000rpm. The abdomen was expanded and stiff. The intra-abdominal pressure (IAP) (measured by Unometer Abdopressure Convatec USA) was 18 cmH2O. A naso-gastric tube and a rectal tube (Rectal tube, Bicakcilar- Istanbul, Turkye) were placed. The drainage from the rectal tube was 2500ml of liquid stools in 2 hours. The IAP dropped to 9 cmH2O, and ECMO blood flow raised to 3.2 lpm. The drainage gave to the ECMO a correct blood flow returns from the cannulas and the return to a normal BF. Conclusion We recommend is a careful assessment of intra-abdominal pressure in the first 24 hours after the ECMO implant to prevent any drops in flow and systemic pressure.