Background and Aims Regional anesthesia for minimal invasive cardiac surgery (MICS) gained interest as part of Enhanced Recovery After Cardiac Surgery (ERACS) protocols. At our institution, mitral valve surgery through port access (MVS-PA), aortic valve replacement via right anterior thoracotomy (AVR-RAT) and minimally invasive direct coronary artery bypass (MIDCAB) surgery are regularly performed MICS procedures. This study aims to investigate whether the addition of a single-shot SAPB to the standard institutional practice reduces NRS in MICS patients.
Methods After obtaining consent, 80 MICS patients were randomized to receive either an additional SAPB after surgery (levobupivacaine 0.25%, dosed at 1.25 mL/kg) or IV piritramide as per protocol alone. The primary outcome is Numeric Rating Scale (NRS), 6 hours after extubation. Secondary outcome measure is total piritramide consumption in the ICU. A subgroup analysis per MICS procedure is performed.
Results In the SAPB group (n = 42), MIDCAB patients had a significant NRS reduction of nearly 2 points (difference: 1.71; 95% CI: 0.412 – 2.945; p = 0.023). In the SAPB group, postoperative opioid consumption was reduced by 2.3 mg; however, the 95% CI spans 0 (-3.948 – 7.344; p = 0.048).
Conclusions In patients undergoing a MIDCAB procedure, our study demonstrates adequate pain relief when a superficial SAPB is performed. Reported pain scores at 6h and piritramide consumption were lower during ICU stay. Future research needs to investigate the added value of the SAPB in the recovery of MICS patients.
MMS 2021.042.01 Goedkeuring EC AZMM B0172021000006 20220331(amendement)
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