Background and Aims Minimally-invasive, on-bypass cardiac surgery (MIC) through a unilateral mini-thoracotomy is increasingly popular but associated with high levels of postoperative pain, opioid consumption and opioid-associated side effects. This study aimed to elucidate whether adding a PECS block II to conventional multimodal analgesia improves opioid consumption, pain and quality of recovery.
Methods After approval by the ethics committee, patients scheduled for MIC were randomized between ultrasound-guided, preoperative unilateral PECS block with ropivacaine 0.5% vs. placebo (saline). Patients, practitioners and data collectors were blinded to the intervention drug; a standardized multimodal analgesic protocol was applied to all patients. Numerical rating scores (NRS), analgesic consumption and the Overall Benefit of Analgesia Score (OBAS) were collected at different time points up to 24 hours postoperatively, and compared between groups.
Results 57 patients were included (ropivacaine n=28, vs. placebo n=29). Block performance (after central venous access) took 5±2.5 minutes. Patients in the ropivacaine group had significantly lower morphine milligram equivalents (MME) during the first 24 hours after extubation (median (interquartile range): 4.2 (2.1-7.6) vs 8.3 (4.2-15.7) mg, p=0.016). NRS at extubation was lower in the ropivacaine group (0.0 (0.0-2.0) vs 1.5 (0.3-3.0), p=0.041). Non-opioid analgesic consumption was similar. The OBAS was, by trend, improved in the ropivacaine group (4.0 (3.0-6.0) vs. 7.0 (3.0-9.0), p=0.082). (table 1)
Conclusions The addition of PECS II block to conventional, opioid-based multimodal analgesia protocols is a simple, yet effective measure to optimize opioid consumption, pain relief and side effect profile in patients undergoing MIC.
ethics pecs II block
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