Ultrasound-guided blocks for cardiovascular surgery: which block for which patient?

Smith, Lauren M.; Barrington, Michael J.

doi:10.1097/aco.0000000000000818

Cited by 37 publications

(37 citation statements)

References 47 publications

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“…After open heart operations, approximately 3.3% of patients may continue using opioid even after 90 days. Hyperalgesia due to opioid use can be an important problem and remifentanil/fentanyl infusions used during the operation may also cause this situation [29,30]. ESPB studies in coronary artery bypass surgeries are few and mostly in the form of case reports.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries

Coşarcan

Doğan

Gürkan

et al. 2021

Cureus

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IntroductionVarious regional anesthesia techniques such as thoracic epidural, thoracic paravertebral block, erector spinae plane block (ESPB), parasternal intercostal blocks are used in cardiac surgery for postoperative analgesia. In our study, we investigated the analgesic efficacy of the dual injection technique of ESPB in beating heart coronary bypass surgeries. MethodsThe records of patients with coronary artery bypass (CABG) surgery in the beating heart at the VKV American Hospital between January and December 2019 were retrospectively analyzed. The data of 30 patients who met the criteria to be included in the study were analyzed. Whether any opioid use is required for maintenance of anesthesia it is recorded. The pain scores of the patients are recorded by the intensive care team and cardiovascular service nurses for the first 48 hours. ResultsThe absence of secondary responses to pain in all surgical periods, including skin incision and sternotomy, and low number of rating scale (NRS) scores in the postoperative 0-to 24-hour period show that the technique we developed can produce effective analgesia. After the 24th postoperative hour, the patients were followed up in the cardiovascular service and there was no opioid use between 24-to 48-hour period. ConclusionOur approach, in which the local anesthetic is applied by approaching the superior costa-transverse ligament (SCTL) in the ESPB, provides an effective analgesia in coronary artery bypass surgeries in the beating heart. The main purpose of our new approach is to increase the amount of local anesthetic in the paravertebral area. We recommend using our modified technique for effective analgesia after CABG surgeries.

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Section: Discussionmentioning

confidence: 99%

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries

Coşarcan

Doğan

Gürkan

et al. 2021

Cureus

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“…Several management strategies are available for reducing postoperative pain, including opioids, anticonvulsants,[ 9 ] continuous local anesthetic infiltration, nerve blocks, intrapleural local anesthetics, alpha-adrenergic agonists, intrathecal techniques, and epidural techniques. [ 13 ] Multimodal analgesia offers a synergistic effect that maximizes pain relief at a lower analgesic dose.…”

Section: Discussionmentioning

confidence: 99%

Pain perception assessment using the short-form McGill pain questionnaire after cardiac surgery

et al. 2020

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Background: Pain management remains an integral part of patient care after cardiac surgery, and it required proper pain assessment. The aim of the study was to assess pain perception using validated Arabic version of the short-form McGill Pain Questionnaire (SF-MPQ) and to identify analgesics prescribing patterns post cardiac surgery. Methods: This is a prospective study conducted in an adult cardiac critical care unit of a tertiary cardiac center from September 2018 to March 2019. The study enrolled 74 patients who underwent cardiac surgical procedures through a median sternotomy. Results: The mean age of our patients was 57 ± 11 years and 47 (63.5%) were males. Patients described post-cardiac surgery pain as heavy ( n = 37; 50%) and tiring-exhausting ( n = 49; 66%), mainly at the site of incision ( n = 20; 27%). Pain intensity at day 1 according to pain rating index (PRI) and numerical rating scale (NRS) was 7 (25 th , 75 th percentiles: 2.8–15) and 6 (3–8), respectively. There was a significant change in pain intensity score between 2 days of assessment (PRI: 7 [2.8–15] vs 5 [2–11] P = 0.010; NRS: 6 (3–8) vs 5 (2–8), P = 0.021]). The most common analgesics prescribed were paracetamol (39%) and a combination of tramadol and paracetamol (33.8%). Conclusion: Pain decreased the second day after cardiac surgery compared to day 1. Paracetamol was the most prescribed analgesic; however, there was an underutilization which might be affected by insufficient pain reporting. Future improvement could focus on multimodal pain management and proper communication of pain experience.

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“…Ultrasound-guided nerve block is different from conventional techniques. Traditional methods identify target nerves by looking for paresthesia methods through body surface anatomical location or inducing neuromuscular contraction by nerve stimulator, but traditional methods cannot achieve visualization of puncture points [ 11 ]. Ultrasound imaging can visualize the nerve that needs to be blocked, as well as the accompanying blood vessels and important tissues around the nerve.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Images Guided under Deep Learning in the Anesthesia Effect of the Regional Nerve Block on Scapular Fracture Surgery

Liu

Cheng

2021

Journal of Healthcare Engineering

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In order to discuss the clinical characteristics of patients with scapular fracture, deep learning model was adopted in ultrasound images of patients to locate the anesthesia point of patients during scapular fracture surgery treated with the regional nerve block. 100 patients with scapular fracture who were hospitalized for emergency treatment in the hospital were recruited. Patients in the algorithm group used ultrasound-guided regional nerve block puncture, and patients in the control group used traditional body surface anatomy for anesthesia positioning. The ultrasound images of the scapula of the contrast group were used for the identification of the deep learning model and analysis of anesthesia acupuncture sites. The ultrasound images of the scapula anatomy of the patients in the contrast group were extracted, and the convolutional neural network model was employed for training and test. Moreover, the model performance was evaluated. It was found that the adoption of deep learning greatly improved the accuracy of the image. It took an average of 7.5 ± 2.07 minutes from the time the puncture needle touched the skin to the completion of the injection in the algorithm group (treated with artificial intelligence ultrasound positioning). The operation time of the control group (anatomical positioning) averaged 10.2 ± 2.62 min. Moreover, there was a significant difference between the two groups ( p < 0.05 ). The method adopted in the contrast group had high positioning accuracy and good anesthesia effect, and the patients had reduced postoperative complications of patients (all P < 0.005 ). The deep learning model can effectively improve the accuracy of ultrasound images and measure and assist the treatment of future clinical cases of scapular fractures. While improving medical efficiency, it can also accurately identify patient fractures, which has great adoption potential in improving the effect of surgical anesthesia.

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Ultrasound-guided blocks for cardiovascular surgery: which block for which patient?

Cited by 37 publications

References 47 publications

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries

Pain perception assessment using the short-form McGill pain questionnaire after cardiac surgery

Ultrasound Images Guided under Deep Learning in the Anesthesia Effect of the Regional Nerve Block on Scapular Fracture Surgery

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