Ultrasound-Guided PECS II + Serratus Plane Fascial Blocks Are Associated with Reduced Opioid Consumption and Lengths of Stay for Minimally Invasive Cardiac Surgery: An Observational Retrospective Study

Abstract

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.

Combinations of nerve blocks in surgery for post COVID-19 pulmonary sequelae patient: A case report and review of literature

“…Implementations of the PECS-II block were targeted to cover the intercostobrachial nerve, but did not completely block it. In some cases, even the intercostobrachial nerve can be blocked with the PECS-II block alone; however, the intercostobrachial nerve is often considered to be sparing[ 23 ]. The covered range varies depending on the volume, injection location, and skill level.…”

The anesthesia management of totally thoracoscopic cardiac surgery: A single-center retrospective study

“…Considering that high-dose opioid therapy is associated with prolonged intubation and ventilator-associated pneumonia, which may lead to a longer ICU stay and higher mortality [ 28 ], we adopted a multimodal analgesia strategy with SAPB as the main intervention. Several high-quality randomized controlled trials have found that SAPB allows better pain management and reduces the use of rescue analgesia [ 29 , 30 ]. In this study, we reviewed patients’ VAS scores and consumption of rescue morphine on the first and third day after surgery, respectively, the results showed that there were 13 patients complained of moderate pain (VAS:4–6) and received rescue morphine.…”

Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2

“…Literature Findings. Perioperative use of SAPB alone or in combination with PECS block 198 in patients undergoing MICS demonstrated reduced postoperative pain scores 198,199 and/or opioid requirements 198,200,201 when compared to controls with either no block 198,199,201 or wound 200 infiltration (category A3-E evidence, 199 category B1-B evidence, 201 and category B2-B evidence 198,200 ).…”