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Abstract
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Background and Aims Myxomas represent the most prevalent primary cardiac neoplasms and are linked with a wide variety of symptoms which affect patients’ quality of life. We present a pioneering case employing erector spinae plane block (ESPB) for perioperative analgesia in a patient with a left atrial myxoma.
Methods A 57-year-old white male presented in the emergency department with dyspnea on rest. His medical history included hyperlipidemia and bilateral carotid stenosis <40%. Preoperative assessments revealed a 3 x 4 cm myxoma of the left atrium, minor mitral and tricuspid regurgitation, with a good ejection fraction. The patient was led to surgery, for surgical excision of the myxoma. Anesthesia comprised of an ultrasound-guided, bilateral ESPB with ropivacaine 0.375%, 20 ml on each side and general anesthesia (induction with fentanyl, hypnomidate, propofol and rocuronium and maintenance with sevoflurane).
Results Hemodynamic stability was maintained throughout surgery without additional analgesia. Surgical duration was 100 minutes (extracorporeal circulation duration was 50 minutes), with a total anesthesia time of 135 minutes. After completion of surgery, the patient was extubated successfully and was transferred to the surgical ward, after staying at the post anesthesia care unit for 60 minutes. Postoperatively, the patient received intravenous paracetamol (1000 mg x 4), without the need of further analgesia and was discharged from the hospital after 3 days.
Conclusions ESPB combined with general anesthesia provided effective perioperative analgesia for left atrial myxoma excision, facilitating hemodynamic stability and early postoperative mobilization and discharge. This case highlights the potential utility of ESPB in managing perioperative pain in cardiac surgery.
Left Atrial Myxoma