Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

Jun Cao,Xiaoyun Gao,Junfeng Zhang,Jing Li,Xiaoli Zhang

doi:10.1186/s12871-020-01082-y

Jun Cao, Xiaoyun Gao + Show 3 more

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https://doi.org/10.1186/s12871-020-01082-y

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Abstract

BackgroundThe laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. We evaluated the feasibility of general anesthesia with an LMA associated to a thoracic paravertebral block (TPB) and/or an erector spinae plane block (ESPB) for internal fixation of rib fractures.MethodsTwenty patients undergoing unilateral rib fracture fixation surgery were enrolled. Each patient received general anesthesia with an LMA combined with TPB and/or ESPB, which provided a successful blocking effect. All patients received postoperative continuous analgesia (PCA) with 500 mg of tramadol and 16 mg of lornoxicam, and intravenous injection of 50 mg of flurbiprofen twice a day. Our primary outcomes including the partial pressure of arterial oxygen (PaO2) and arterial carbon dioxide (PaCO2) were measured preoperatively and on the first day after surgery. Secondary outcomes including the vital signs, ventilation parameters, postoperative numerical rating scale (NRS) pain scores, the incidence of postoperative nausea and vomiting (PONV), perioperative reflux and aspiration, and nerve block-related complications were also evaluated.ResultsThirteen men and seven women (age 35–70 years) were enrolled. Six (30%) had a flail chest, nine (45%) had hemothorax and/or pneumothorax, and two (10%) had pulmonary contusions. The postoperative PaO2 was higher than the preoperative value (91.2 ± 16.0 vs. 83.7 ± 15.9 mmHg, p = 0.004). The preoperative and postoperative PaCO2 were 42.1 ± 3.7 and 43.2 ± 3.7 mmHg (p = 0.165), respectively. Vital signs and spontaneous breathing were stable during the surgery. The end-tidal carbon dioxide concentrations (EtCO2) remained within an acceptable range (≤ 63 mmHg in all cases). NRS at T1, T2, and T3 were 3(2,4), 1(1,3), and 0(0,1), respectively. None had PONV, regurgitation, aspiration, and nerve block-related complications.ConclusionsThe technique of laryngeal mask anesthesia combined with a nerve block was feasible for internal fixation of rib fractures.Trial registrationCurrent Controlled Trials ChiCTR1900023763. Registrated on June 11, 2019.

Highlights

The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures
No patient required endotracheal intubation (ETI) anesthesia owing to the poor position of the LMA or insufficient ventilation
In this study, we found that LMA anesthesia combined with nerve blocks such as thoracic paravertebral block (TPB) and erector spinae plane block (ESPB) could offer satisfactory

Summary

Introduction

The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. General anesthesia with endotracheal intubation (ETI) was considered mandatory for rib fracture surgery It might cause ventilator-induced lung injury (VILI) [2] and the patients might have delayed awakening or even need re-intubation owing to residual general anesthetics [3]. LMA anesthesia combined with a nerve block could offer an enhanced recovery owing to the possibility of a fast and coughless extubation and effective postoperative analgesia with less opioid [4]. We designed this prospective observational study to evaluate the feasibility of general anesthesia with an LMA associated to regional anesthesia in elderly patients undergoing internal fixation of rib fractures

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