Serratus anterior plane block for minimal invasive heart surgery

Vivien Berthoud,Maxime Nguyen,Claude Girard,Belaid Bouhemad,Omar Ellouze,Pierre-Gregoire Guinot,Ghislain Malapert,Serge Aho,Maria Konstantinou,Olivier Bouchot

doi:10.1186/s12871-018-0614-5

Abstract

BackgroundMinimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. Our objective was to compare efficacy of serratus anterior plane block (SAPB) with continuous wound infiltration (CWI) for management of post-operative pain following MIHS.MethodsIt’s retrospective, monocentric study between November 2016 to April 2017. The study was performed at the University hospital of Dijon, Burgundy, France. All patients scheduled for MIHS was included. Data was collected retrospectively. During this period, 20 patients had SAPB and 26 had CWI. SAPB was performed before extubation with a single injection of 0.5 mg/kg of ropivacaïne (5 mg/ml). In the CWI group, catheter was inserted in the subcutaneous space by the surgeon at the end of the procedure. A 10 ml bolus of ropivacaïne (7.5 mg/mL) was followed by a continuous infusion (2 mg/ml) between 7 and 12 ml/h for 48 h. Morphine consumption and visual analog score (VAS) were recorded for 48 h. Length of stay in intensive care unit and hospital was also collected.ResultsMorphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group.ConclusionSAPB appears effective in reducing postoperative MIHS pain.

Highlights

Minimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain
Baseline characteristics During the observational period, 345 patients were screened in cardiac surgery, 48 patients have operated by MISH, and 2 patients were excluded for prolonged mechanical ventilation more than 24 h postoperatively, 1 for acute respiratory distress syndrome and one for hemorrhagic shock with surgical revision
Our study demonstrated that patients treated with serratus anterior plane block (SAPB) had a significantly lower total morphine consumption during the first 48 h following minimally invasive heart surgery and lower Numeric rating scale (NRS)

Summary

Introduction

Minimal invasive heart surgery (MIHS) presents several benefits, but provides intense and prolonged post-operative pain. During this period, 20 patients had SAPB and 26 had CWI. Results: Morphine consumption and VAS score were significantly lower in SAPB group (p < 0.01). Length of stay in intensive care and hospital was significantly was decreased in SAPB group. Minimally-invasive heart surgery (MIHS) for aortic, mitral valve replacement or repair has developed rapidly. It presents several advantages including decreasing the risk of mediastinitis, leaving a more esthetic scar, facilitating post-operative rehabilitation and reducing hospital length of stay, compared with sternotomy [1]. It is most severe during the first 48 h after surgery with repercussions on breathing, cognitive, urinary and digestive function, and may prevent early rehabilitation.

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