Objective Postoperative Pain Assessment Using Incentive Spirometry Values: A Prospective Observational Study

Hallman, Matthew J; Dorinsky, Nancy; Li, Quefeng; Isaak, Robert S.; Kolarczyk, Lavinia; Kim, Hong Joo; Lobonc, Andrew

doi:10.2217/pmt-2020-0080

Cited by 1 publication

(1 citation statement)

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“…[29][30][31] Moreover, incentive spirometry performance has been used as an indicator of regional analgesia efficacy and objective surrogate data for postoperative pain control. 32,33 After cardiac surgery, patients inevitably experience respiratory function decline due to factors such as atelectasis from general anesthesia, ischemia-reperfusion injury, or distressing pain. 34,35 Thus, in our study, we compared the spirometry %baseline (daily volume divided by the baseline volume) instead of the absolute daily incentive spirometry volume.…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study

Liang,

Shen,

et al. 2024

Journal of the Chinese Medical Association

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Background: Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block versus conventional care in reducing opioid consumption and enhancing respiratory function recovery post-cardiac surgery over 72 hours. Methods: A retrospective study at a tertiary hospital (Jan 2021 - Jul 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n=53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy). Results: Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95%CI 60-157.5mg, p < 0.001; thoracotomy: 172.5mg, 95%CI 45-285mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), an higher incentive spirometry volumes (sternotomy: mean increase of 149mL, p = 0.019; thoracotomy: 521mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001). Conclusion: Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.

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