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Engin M, Aydın U, AS AK, Ata Y, Yavuz Ş. Cryoablation Catheter Used in the Surgical Treatment of Atrial Fibrillation May Treat Chest Tube Pain: Engin Technique. Braz J Cardiovasc Surg 2024; 39:e20230354. [PMID: 38748605 PMCID: PMC11093227 DOI: 10.21470/1678-9741-2023-0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 05/19/2024] Open
Abstract
Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.
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Affiliation(s)
- Mesut Engin
- Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ufuk Aydın
- Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ahmet Kağan AS
- Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Yusuf Ata
- Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Şenol Yavuz
- Department of Cardiovascular Surgery, University of Health
Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Smith D, Tsui BCH, Khoo C. Local Anesthetic Systemic Toxicity in Cardiac Surgery Patient with Erector Spinae Plane Catheter: A Case Report. A A Pract 2024; 18:e01771. [PMID: 38578011 DOI: 10.1213/xaa.0000000000001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Regional anesthesia nerve blocks are increasingly used for patients undergoing cardiac surgery as part of multimodal pain management. Though rare, local anesthetic systemic toxicity (LAST) is a severe complication that requires vigilant monitoring. We present a case of a postcardiac surgery patient who developed LAST multiple days after surgery from lidocaine via an erector spinae plane catheter. This episode was determined to be a result of impaired lidocaine metabolism from liver shock caused by worsening pulmonary hypertension. Even under continuous monitoring, patients with cardiac or liver dysfunction are at increased risk of complications from local anesthetics.
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Affiliation(s)
- Derek Smith
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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Dalir Z, Seddighi F, Esmaily H, Abbasi Tashnizi M, Ramezanzade Tabriz E. Effects of virtual reality on chest tube removal pain management in patients undergoing coronary artery bypass grafting: a randomized clinical trial. Sci Rep 2024; 14:2918. [PMID: 38316860 PMCID: PMC10844628 DOI: 10.1038/s41598-024-53544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
The pain associated with chest tube removal (CTR) is one of the significant complications of cardiac surgery. The management of this pain is recognized as a vital component of nursing care. The application of distraction techniques using virtual reality (VR) is an effective and straightforward non-pharmacological approach to alleviate pain. This study aimed to determine the impact of VR technology on the management of pain caused by CTR following coronary artery bypass grafting (CABG). This randomized clinical trial was conducted on 70 patients undergoing CABG at Imam Reza and Qaem hospitals in Mashhad, Iran, in 2020. The patients were randomly divided into two groups of 35. For the intervention group, a 360-degree video was played using VR glasses 5 min before the CTR procedure. The pain intensity was measured before, immediately after, and 15 min after CTR, using the Visual Analogue Scale. Also, the Depression Anxiety and Stress Scale-21 (DASS-21), and the Rhoten Fatigue Scale (RFS) were used to evaluate intervention and control groups before the CTR procedure. The collected data was analyzed using statistical tests, such as Chi-square, independent t-test, and Mann-Whitney test. The patients were homogeneous in terms of stress, anxiety, and fatigue levels before CTR, and they did not show any significant differences (P > 0.05). The average pain intensity score of patients in the intervention group significantly decreased immediately and 15 min after CTR, compared to the control group (P < 0.001). Given the positive impact of VR distraction on the severity of pain associated with CTR in patients undergoing CABG, this technique can serve as an effective, accessible, and cost-efficient non-pharmacological approach for managing pain in these patients.Trial registration: This study was registered in the Iranian Registry of Clinical Trials (code: IRCT20190708044147N1; approval date, 08/26/2019).
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Affiliation(s)
- Zahra Dalir
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Azadi Square, Shahid Dr. Kharazmi Educational Complex, PO Box 9177949025, Mashhad, Iran
| | - Fatemeh Seddighi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Azadi Square, Shahid Dr. Kharazmi Educational Complex, PO Box 9177949025, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Abbasi Tashnizi
- Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Ramezanzade Tabriz
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Azadi Square, Shahid Dr. Kharazmi Educational Complex, PO Box 9177949025, Mashhad, Iran.
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Guinot PG, Besch G, Hameury B, Grelet T, Mertes PM, Nguyen M, Bouhemad B. Protocol Study for the Evaluation of Non-Opioid Balanced General Anaesthesia in Cardiac Surgery with Cardiopulmonary Bypass: A Randomised, Controlled, Multicentric Superiority Trial (OFACAR Study). J Clin Med 2023; 12:5473. [PMID: 37685539 PMCID: PMC10487869 DOI: 10.3390/jcm12175473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Opioid-free anaesthesia (OFA) is general anaesthesia based on the use of several non-opioid molecules that aim to have an analgesic effect, decrease the sympathetic response, decrease hormonal stress, and decrease the inflammatory response during surgery. Although this approach to anaesthesia is regularly used in clinical practice, it remains a novel approach. The literature on this anaesthesia modality finds a number of positive effects on cardiac, respiratory, and cognitive function but no randomised study evaluated these effects during cardiac surgery where there is a high incidence of postoperative complications. The main aim of the study is to compare OFA vs. standard balanced opioid general anaesthesia on the incidence of postoperative complications and the length of stay in intensive care and hospital. OFACAR is a multicentric, randomised, controlled, superiority, single-blind, two parallel-arm clinical trial in patients undergoing cardiac surgery with cardiopulmonary bypass. We compared a balanced general anaesthesia without opioids (OFA group) vs. a balanced opioid general anaesthesia with sufentanil (control group). One hundred and sixty patients will be enrolled in each treatment group. The primary endpoint is a composite one which corresponds to the occurrence of at least one of the postoperative complications, defined according to European standards within 30 days after surgery. Recruitment started in September 2019, and data collection is expected to end in November 2024.
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Affiliation(s)
- Pierre-Grégoire Guinot
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; (B.H.); (M.N.); (B.B.)
- University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France
| | - Guillaume Besch
- Department of Anaesthesiology and Critical Care Medicine, Besançon Regional University Medical Centre, 25030 Besançon, France; (G.B.); (T.G.)
- EA3920, University of Franche-Comté, 25000 Besançon, France
| | - Bastien Hameury
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; (B.H.); (M.N.); (B.B.)
| | - Tommy Grelet
- Department of Anaesthesiology and Critical Care Medicine, Besançon Regional University Medical Centre, 25030 Besançon, France; (G.B.); (T.G.)
| | - Paul Michel Mertes
- Department of Anesthesia and Critical Care, University Hospital of Strasbourg, 67200 Strasbourg, France;
| | - Maxime Nguyen
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; (B.H.); (M.N.); (B.B.)
- University of Burgundy and Franche-Comté, LNC UMR1231, F-21000 Dijon, France
| | - Belaid Bouhemad
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000 Dijon, France; (B.H.); (M.N.); (B.B.)
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De Bels D, Bousbiat I, Perriens E, Blackman S, Honoré PM. Sedation for adult ICU patients: A narrative review including a retrospective study of our own data. Saudi J Anaesth 2023; 17:223-235. [PMID: 37260674 PMCID: PMC10228859 DOI: 10.4103/sja.sja_905_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 06/02/2023] Open
Abstract
The optimization of patients' treatment in the intensive care unit (ICU) needs a lot of information and literature analysis. Many changes have been made in the last years to help evaluate sedated patients by scores to help take care of them. Patients were completely sedated and had continuous intravenous analgesia and neuromuscular blockades. These three drug classes were the main drugs used for intubated patients in the ICU. During these last 20 years, ICU management went from fully sedated to awake, calm, and nonagitated patients, using less sedatives and choosing other drugs to decrease the risks of delirium during or after the ICU stay. Thus, the usefulness of these three drug classes has been challenged. The analgesic drugs used were primarily opioids but the use of other drugs instead is increasing to lessen or wean the use of opioids. In severe acute respiratory distress syndrome patients, neuromuscular blocking agents have been used frequently to block spontaneous respiration for 48 hours or more; however, this has recently been abolished. Optimizing a patient's comfort during hemodynamic or respiratory extracorporeal support is essential to reduce toxicity and secondary complications.
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Affiliation(s)
- David De Bels
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Ibrahim Bousbiat
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Emily Perriens
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Sydney Blackman
- Intensive Care Unit, Brugmann University Hospital, Brussels, Belgium
| | - Patrick M Honoré
- Department of Intensive Care, CHU UCL Godinne Namur, UCL Louvain Medical School, Yvoir, Belgium
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Wang L, Jiang L, Jiang B, Xin L, He M, Yang W, Zhao Z, Feng Y. Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:90. [PMID: 36959543 PMCID: PMC10035143 DOI: 10.1186/s12871-023-02044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
Background Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, but many patients complain of severe drainage pain that cannot be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, but whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB + RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 h after surgery. Secondary outcomes included opioid consumption within 48 h, postoperative pain scores, time to extubation, and length of stay in the hospital. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α before and the first 24 h after surgery were measured. Results A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 h after surgery was 2.33 ± 1.77 mg in the PIFB + RSB group vs 3.81 ± 2.24 mg in the PIFB group (p = 0.010). Opioid consumption within 48 h after surgery was also reduced in the PIFB + RSB group (4.71 ± 2.71 mg vs 7.25 ± 3.76 mg, p = 0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, or the levels of IL-6, IL-10 and TNF-α between the two groups. Conclusions The combination of PIFB and RSB reduced postoperative intravenous opioid consumption until 48 h after cardiac surgery. Trial registration This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.
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Affiliation(s)
- Lu Wang
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
| | - Luyang Jiang
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
| | - Bailin Jiang
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
| | - Ling Xin
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
| | - Miao He
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
| | - Wei Yang
- grid.411634.50000 0004 0632 4559Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, China
| | - Zhou Zhao
- grid.411634.50000 0004 0632 4559Department of Cardiac Surgery, Peking University People’s Hospital, Beijing, China
| | - Yi Feng
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, 100044 China
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Ward CT, Moll V, Boorman DW, Ooroth L, Groff RF, Gillingham TD, Pyronneau L, Prabhakar A. The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery. J Cardiothorac Surg 2022; 17:342. [PMID: 36581941 PMCID: PMC9801617 DOI: 10.1186/s13019-022-02067-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Enhanced Recovery after Surgery Cardiac Society recommends using multimodal analgesia (MMA) for postoperative pain however, evidence-based guidelines have yet to be established. This study examines the impact of a standardized postoperative MMA pathway in reducing opioid consumption and related complications after cardiothoracic surgery (CTS). METHODS Within a multicenter healthcare system, a postoperative MMA pathway was developed and implemented at two CTS intensive care units (ICU) while the other CTS ICU opted to maintain the existing opioid-based pathway. A retrospective chart review was conducted on patients admitted to a CTS ICU within this healthcare system after conventional coronary artery bypass grafting and/or valve surgery from September 1, 2018, to June 30, 2019. Comparative analysis was conducted on patients prescribed MMA versus those managed with an opioid-based pathway. The primary outcome was total opioid consumption, converted to morphine milligram equivalents, 72-h post-surgery. Secondary outcomes included mobility within one-day post-surgery, ICU length of stay (LOS), time to first bowel movement (BM), and time to first zero Richmond Agitation-Sedation Scale (RASS). RESULTS Seven hundred sixty-two adults were included for final analysis. The MMA group had a higher body mass index, higher percentage of females, were more likely classified as African American and had higher scores for risk-adjusted complications. General Linear Model analysis revealed higher opioid consumption in the MMA group (Est. 0.22, p < 0.0009); however, this was not statistically significant after adjusting for differences in fentanyl usage. The MMA group was more likely to have mobility within one-day post-surgery (OR 0.44, p < 0.0001), have longer time to first BM (OR 1.93, p = 0.0011), and longer time to first zero RASS (OR 1.62, p = 0.0071). The analgesia groups were not a predictor for ICU LOS. CONCLUSIONS Opioid consumption was not reduced secondary to this postoperative MMA pathway. The MMA group was more likely to have mobility within one-day post-surgery. Patients in the MMA group were also more likely to have prolonged time to first BM and first zero RASS. Development and evaluation of a perioperative MMA pathway should be considered.
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Affiliation(s)
- Ceressa T. Ward
- Convergent Genomics, 425 Eccles Avenue, South San Francisco, CA 94080 USA ,grid.505042.6Potrero Medical, Hayward, CA USA
| | - Vanessa Moll
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA ,grid.505042.6Potrero Medical, Hayward, CA USA
| | - David W. Boorman
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
| | - Lijo Ooroth
- grid.259906.10000 0001 2162 9738Mercer University College of Pharmacy, Atlanta, GA USA
| | - Robert F. Groff
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
| | - Trent D. Gillingham
- grid.462222.20000 0004 0382 6932Office of Quality, Emory Healthcare, Atlanta, GA USA
| | | | - Amit Prabhakar
- grid.189967.80000 0001 0941 6502Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA USA
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Lee IWS, Schraag S. The Use of Intravenous Lidocaine in Perioperative Medicine: Anaesthetic, Analgesic and Immune-Modulatory Aspects. J Clin Med 2022; 11:jcm11123543. [PMID: 35743617 PMCID: PMC9224677 DOI: 10.3390/jcm11123543] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 12/14/2022] Open
Abstract
This narrative review provides an update on the applied pharmacology of lidocaine, its clinical scope in anaesthesia, novel concepts of analgesic and immune-modulatory effects as well as the current controversy around its use in perioperative opioid-sparing multi-modal strategies. Potential benefits of intravenous lidocaine in the context of cancer, inflammation and chronic pain are discussed against concerns of safety, toxicity and medico-legal constraints.
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Affiliation(s)
- Ingrid Wing-Sum Lee
- School of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow G12 8QQ, UK;
| | - Stefan Schraag
- Department of Perioperative Medicine, Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK
- Correspondence: ; Tel.: +44-7799878261
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