Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery

Bălan, Cosmin; Bubenek-Turconi, Şerban-Ion; Tomescu, Dana; Văleanu, Liana

doi:10.3390/medicina57040312

Cited by 22 publications

(13 citation statements)

References 90 publications

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“…ESPB, as an ultrasound-guided PVB variant, was first described in 2016 ( 90 ). ESPB blocked dorsal and ventral rami of spinal nerve roots as same as PVB ( 85 , 91 ). ESPB not only had a greater analgesic benefit in the first six hours after tracheal extubation, but also reduced the risk of pruritus in our analysis.…”

Section: Discussionmentioning

confidence: 86%

“…PINB, TTMPB, and PIFB complement the anteromedial chest wall by providing anesthesia confined to the parasternal region. According to the nuance of the injection position, they were divided into two categories: regional anesthetics was injected between the internal intercostal and pectoralis major muscles in PIFB and PINB; regional anesthetics was deeply injected between the internal intercostal and transverse thoracic muscles in TTMPB ( 3 , 91 , 92 ). All these three techniques anesthetized the anterior branches of the intercostal nerves.…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers believed that PINB and PIFB were the same blocks ( 95 ). Some authors promoted PIFB because of easily identify with ultrasound ( 91 ). Although pain scores at 6, 12 h at rest were lower for TTMPB, evidence for cardiac surgery patients is extremely limited.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Zhou

Song

2023

Front. Cardiovasc. Med.

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BackgroundPatients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear.MethodsFive databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality.ResultsThis meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016–0.55), shortened the time to tracheal extubation (MD = −181.55, 95% CI: −243.05 to −121.33) and the duration of hospital stay (MD = −0.73, 95% CI: −1.22 to −0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques.ConclusionsTEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, ID: CRD42021276645

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Zhou

Song

2023

Front. Cardiovasc. Med.

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“…In this study population, block-related complications were not observed (pneumothorax, nerve injury, LAST); however, these are rarely described in the literature [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

Torre

Pirri

Contristano³

et al. 2022

Life

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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.

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“…Balan et al, in a review article on ultrasound-based monitoring and diagnosis techniques, underline the importance of ultrasound-guided regional anesthetic techniques on the management of nociception-antinociception balance and the impact of these techniques on opioid consumption, patient satisfaction, and postoperative recovery [4]. Fiedler et al, in an original article, have analyzed a method that is frequently used in ventilatory support for patients under general anesthesia.…”

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confidence: 99%

General Anesthesia as a Multimodal Individualized Clinical Concept

Rogobete

Săndesc

2022

Medicina

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In the last decades, several new and modern techniques have been developed for the continuous monitoring of vitals for patients undergoing surgery under general anesthesia. These complex methods are meant to come as an adjunct to classical monitoring protocols used in general anesthesia to increase patient safety. The main objectives of multimodal monitoring are avoiding the over- or underdosing of anesthetic drugs, adapting the concentration for the substances in use, reducing post-anesthetic complications, and increasing patient comfort. Recent studies have shown a series of benefits with significant clinical impact such as a reduced incidence of nausea and vomiting, shorter reversal times, a reduction in opioid consumption, shorter hospital stays, and an increase in patient satisfaction.

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Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery

Abstract: With the advent of fast‐track pathways after cardiac surgery, there has been a renewed interest in regional anesthesia due to its opioid‐sparing effect[...]

Cited by 22 publications

References 90 publications

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis

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

General Anesthesia as a Multimodal Individualized Clinical Concept

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