Abstract
BackgroundSpinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization. Continuous extrapleural intercostal nerve block (CEINB) is a postoperative pain treatment for intercostal thoracotomy, with fewer complications. Here, we report a case in which imaging evaluation of CEINB with contrast medium was conducted to anatomically confirm the spread of local anesthetics after MICS.Case presentationA 65-year-old woman with severe mitral regurgitation underwent mitral valve plasty under general anesthesia via right-sided mini-thoracotomy. A CEINB catheter was placed before the incision was closed, without creating a conventional extrapleural pocket. We conducted an imaging evaluation with a contrast medium via the inserted catheter and confirmed sufficient spread around the intercostal nerve area. In addition, postoperative pain was well controlled by the nerve block.ConclusionsImaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS.
Highlights
Spinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization
Background minimally invasive cardiac surgery (MICS) is a feasible alternative to conventional full sternotomy with a low incidence of transfusion and general morbidity [1], intercostal thoracotomy causes severe prolonged postoperative pain, which is closely associated with postoperative pulmonary complications
Intercostal nerve block effectively controls pain after MICS; repeated administration of local anesthetics is required for adequate analgesia
Summary
Imaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS.
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