Comprehensive Pain Control Strategy in Minimally Invasive Mitral Valve Repair

Abstract

The effect of our comprehensive strategy to reduce pain after minimally invasive mitral valve repair through a right mini-thoracotomy was assessed retrospectively. Methods: Our comprehensive strategy constituted the following: planned rib cutting to avoid rib injury, sufficient intercostal muscle division to mobilize the cut rib, limiting the number of intercostal ports, avoiding nerve entrapment, continuous extra-pleural intercostal nerve block, and regular use of oral non-steroidal anti-inflammatory drugs. We compared patients treated with this comprehensive strategy (Group S, n = 13) and patients before this strategy was implemented (Group C, n = 13). We used a numerical rating scale (NRS) as a pain scale during the first 3 days postoperatively. Results: The average NRS was significantly lower in Group S (0.82 ± 0.49) than in Group C (2.40 ± 1.46) (P <0.01). The maximum NRS was also significantly lower in Group S (3.23 ± 1.17) than in Group C (5.69 ± 2.43) (P <0.01). The number of patients using additional single-dose analgesic were significantly less in Group S (23.1%) than in Group C (84.6%) (P <0.01). Conclusion: Our comprehensive pain control strategy effectively reduced postoperative pain in minimally invasive mitral valve repair.

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

“…Hosono et al 118 described their comprehensive surgical techniques to minimize postoperative pain after minimally invasive mitral valve repair. They avoid excessive rib spreading and prevent rib injuries by making a planned rib resection.…”

Implementation of Endoscopic Minimally Invasive Mitral Valve Replacement Surgery With Automated Suturing Technology

“…In some hands, minimally invasive procedures via lateral minithoracotomy are known for causing significant postoperative pain from extensive retraction damaging ribs or compromising of the thoracic nerves by the ports for the endoscopic instruments. 19 – 21 Since no rigid bone retractors are used during minimally invasive procedures, it is possible to minimize postoperative pain by avoiding bony compression injury. The number of incisions required for endoscopic instruments and imaging can also be reduced.…”