Continuous PECS II block for postoperative analgesia in patients undergoing transapical transcatheter aortic valve implantation

Abstract

It has been reported that PECS II block can alleviate postoperative pain following transapical transcatheter aortic valve implantation (TA-TAVI). However, the effectiveness of continuous PECS II block with catheterization has not yet been reported on the postoperative pain in patients undergoing TA-TAVI. We experienced two cases of TA-TAVI who received PECS II block with catheterization to manage postoperative pain. In the first case, a bolus injection for intraoperative pain and subsequent catheterization were performed before the implantation. However, the patient developed severe pain postoperatively in spite of the continuous block due to displacement of the catheter. In the second case, a bolus injection and the catheterization for the continuous block were performed before and after the implantation, respectively, which provided high-quality pain control. Continuous PECS II block may be useful to control perioperative pain associated with TA-TAVI. The insertion of the catheter after the implantation could be useful to avoid its displacement during the surgery.

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

“…91 Small case reports have achieved good pain control with continuous catheter infusions after TA-TAVR, although there is a risk of dislodgement. 92 Surgical site infiltration. A single administration of a relatively long-lasting local anesthetic, such as bupivacaine, has been found to decrease pain and opioid use up to 50% after minimally invasive cardiac surgery.…”

“…91 Small case reports have achieved good pain control with continuous catheter infusions after TA-TAVR, although there is a risk of dislodgement. 92…”

Anesthesia for minimally invasive cardiac surgery

“…The PECS II block targets the long thoracic nerve and thoracodorsal nerve (31). The literature evaluating PECS blocks for MICS is sparse, there are several reports of it being used with varying success in TA TAVI procedures (32).…”