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Erector Spinae Regional Anesthesia for Robotic Coronary Artery Bypass Surgery Is Not Associated With Reduced Postoperative Opioid Use: A Retrospective Observational Study


Moll, Vanessa; Ward, Ceressa T; Jabaley, Craig S; O'Reilly-Shah, Vikas N; Boorman, David W; McKenzie-Brown, Anne Marie; Halkos, Michael E; Prabhakar, Amit; Pyronneau, Laura R; Schmidt, Peter C (2020). Erector Spinae Regional Anesthesia for Robotic Coronary Artery Bypass Surgery Is Not Associated With Reduced Postoperative Opioid Use: A Retrospective Observational Study. Journal of Cardiothoracic and Vascular Anesthesia:Epub ahead of print.

Abstract

Objective: Regional anesthesia techniques are gaining traction in cardiac surgery. The aim of this study was to compare the analgesic efficacy of erector spinae plane block catheters (ESPBC), serratus anterior plane block catheters (SAPBC), and paravertebral single-shot block (PVB) versus no block after robotic minimally invasive direct coronary artery bypass (MIDCAB).

Design: This was a retrospective observational study of routinely recorded data.

Setting: The study was performed at a single healthcare system.

Participants: All patients underwent robotic MIDCAB.

Intervention: Data were analyzed from 346 patients during a 53-month period. The clinical data warehouse was queried for all robotic MIDCAB surgeries. Variables abstracted included type of nerve block, age, sex, use of adjuncts, Society of Thoracic Surgeons predicted short length of stay (PSLOS), total opioid consumption during the 72 hours after surgery, and postoperative hospital length of stay (LOS). The primary outcome was total oral morphine milligram equivalents (MME) consumed during the first 72 hours after surgery. The secondary outcome was hospital LOS.

Measurements and main results: In a model adjusting for PSLOS, the authors did not observe an association between ESPBC and the reduction of total administered oral MME within 72 hours after surgery. There was no significant difference in MME when comparing patients who received PVB to patients with ESPBC. Older age and female sex were associated with significantly lower MME. Patients who received ESPBC had a significantly shorter hospital LOS than patients with SAPBC.

Conclusions: These findings suggested that postoperative pain after MIDCAB surgery might not be completely covered by ESPBC. Prospective studies are needed to further elucidate the value of this technique for robotic MIDCAB.

Keywords: acute pain; erector spinae plane block; minimally invasive direct coronary artery bypass; paravertebral block; postoperative pain; serratus anterior plane block.

Abstract

Objective: Regional anesthesia techniques are gaining traction in cardiac surgery. The aim of this study was to compare the analgesic efficacy of erector spinae plane block catheters (ESPBC), serratus anterior plane block catheters (SAPBC), and paravertebral single-shot block (PVB) versus no block after robotic minimally invasive direct coronary artery bypass (MIDCAB).

Design: This was a retrospective observational study of routinely recorded data.

Setting: The study was performed at a single healthcare system.

Participants: All patients underwent robotic MIDCAB.

Intervention: Data were analyzed from 346 patients during a 53-month period. The clinical data warehouse was queried for all robotic MIDCAB surgeries. Variables abstracted included type of nerve block, age, sex, use of adjuncts, Society of Thoracic Surgeons predicted short length of stay (PSLOS), total opioid consumption during the 72 hours after surgery, and postoperative hospital length of stay (LOS). The primary outcome was total oral morphine milligram equivalents (MME) consumed during the first 72 hours after surgery. The secondary outcome was hospital LOS.

Measurements and main results: In a model adjusting for PSLOS, the authors did not observe an association between ESPBC and the reduction of total administered oral MME within 72 hours after surgery. There was no significant difference in MME when comparing patients who received PVB to patients with ESPBC. Older age and female sex were associated with significantly lower MME. Patients who received ESPBC had a significantly shorter hospital LOS than patients with SAPBC.

Conclusions: These findings suggested that postoperative pain after MIDCAB surgery might not be completely covered by ESPBC. Prospective studies are needed to further elucidate the value of this technique for robotic MIDCAB.

Keywords: acute pain; erector spinae plane block; minimally invasive direct coronary artery bypass; paravertebral block; postoperative pain; serratus anterior plane block.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Cardiology and Cardiovascular Medicine
Health Sciences > Anesthesiology and Pain Medicine
Uncontrolled Keywords:Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine
Language:English
Date:1 September 2020
Deposited On:14 Jan 2021 06:53
Last Modified:15 Jan 2021 21:01
Publisher:Elsevier
ISSN:1053-0770
OA Status:Closed
Publisher DOI:https://doi.org/10.1053/j.jvca.2020.09.112
PubMed ID:33127286

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