Jeffrey P Cardinale, Ryan Latimer, Candace Curtis, Yana Bukovskaya, Logan Kosarek, Jason Falterman, Danielle M Tatum, Jay Trusheim
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引用次数: 5
Abstract
Background: The aim for early extubation remains an important goal in cardiac surgical patients. Therefore, employment of a multimodal approach to pain management that includes a transverse thoracic plane block was retrospectively examined at a single-center tertiary care hospital on the effects of time to extubation, opioid consumption, and length of stay in patients undergoing cardiac surgery via median sternotomy.
Methods: Blocks were performed on all cardiac surgical patients except for those undergoing left ventricular assist device placement, thoracic transplant, emergent surgery, or redo sternotomy. Following additional exclusions for intra- and postoperative complications unrelated to anesthesia, final analysis was conducted on 75 patients per group. Multimodal pain management included intravenous analgesics and transverse thoracic plane block where patients received 15 mL 0.5% bupivacaine + epinephrine bilaterally under ultrasound guidance prior to incision.
Results: Following transverse thoracic plane block and multimodal analgesics, 50.6% of patients were extubated in the operation room versus 8.6% in the control group. Intraoperative opioids were decreased, and intensive care unit and total length of stay were reduced by 5 hours and 1 day, respectively, in block patients as compared with controls. Postoperative opioids were not significantly different. There were no reported complications directly attributed to the block.
Conclusions: The transverse thoracic plane block and multimodal regimen for patients undergoing median sternotomy resulted in a significant number of patients extubated in the operation room without an increase in postoperative re-intubations. Moreover, the block appears to be a quick and safe procedure to utilize on cardiac surgery patients.
背景:早期拔管仍然是心脏外科患者的一个重要目标。因此,我们在一家单中心三级医院对拔管时间、阿片类药物使用和胸骨正中切开术心脏手术患者住院时间的影响进行了回顾性研究,其中包括胸椎横切面阻滞。方法:除了接受左心室辅助装置放置、胸腔移植、紧急手术或重做胸骨切开术的患者外,对所有心脏手术患者进行阻滞。在排除与麻醉无关的内、术后并发症后,每组对75例患者进行最终分析。多模式疼痛管理包括静脉镇痛和胸横平面阻滞,患者在切口前超声引导下双侧接受15 mL 0.5%布比卡因+肾上腺素。结果:经胸横平面阻滞加多模式镇痛后,50.6%的患者在手术室拔管,对照组为8.6%。与对照组相比,阻滞患者术中阿片类药物减少,重症监护病房和总住院时间分别减少了5小时和1天。术后阿片类药物无明显差异。没有直接归因于阻滞的并发症报道。结论:胸骨正中切开术患者采用胸横平面阻滞和多模式方案,术后拔管人数显著增加,且术后再插管次数未增加。此外,阻滞似乎是一种快速和安全的程序,用于心脏手术患者。