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ESRA19-0061 Association of multilevel thoracic retrolaminar paravertebral blocks for midcab surgery through left anterior small thoracotomy (LAST) with decreased opioid consumption: 2 case reports
  1. H Ito
  1. Shinmatsudo Central General Hospital, Anesthesiology, Tokyo, Japan


Background and aims Recently, Society for Enhanced Recovery After Cardiac Surgery (ERACS) has been developed with a mission to ‘a multimodal, opioid-sparing, pain management plan is recommended postoperatively.’ We hypothesized that patients receiving multilevel thoracic retrolaminar paravertebral blocks (TRLPVB) would have decreased peri- and postoperative opioid consumption.

Methods Two consecutive patients with normal EF undergoing MIDCAB surgery through LAST without CPB were evaluated. Ipsilateral (left) TRLPVB was performed upon general anesthesia induction completion with 20 ml levobupivacaine (0.25%) for each lamina of the T4 and T5 vertebrae. Postoperative pain was controlled with standardized acetaminophen and/or pentazocine boluses after surgery. Pain was graduated using the numerical rating scale (NRS). The NRS score ranges from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable.

Results Two patients received injection fentanyl 0.15 mg for induction. Intraoperative remifentanil was infused continuously at a rate of 4 ml/hr (2 mg/20 ml) and no increased remifentanil infusions were used between skin incision and closure during surgery. In both patients, peak of the NRS score was 8 on postoperative day (POD) 2. A first required rescue analgesics at 24 hours (h) post-TRLPVB were intravenous (IV) acetaminophen (1000 mg) in both patients. Additional required analgesics at 30 and 36h post-TRLPVB were IV pentazocine (15 mg) in Case 1 and at 47h post-TRLPVB was IV acetaminophen (1000 mg) in Case 2. From POD3 onwards both patients had less pain (NRS < 2) and required no pain medication.

Conclusions In both patients, preoperative multilevel TRLPVB was associated with decreased peri- and postoperative opioid consumption.

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