Analgesia with blockage of the erector plane of the spine in the postoperative period of cardiac surgery. Case report / Analgesia pós-operatória em cirurgia cardíaca pelo bloqueio do plano eretor da espinha. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Persistence of pain in the postoperative thoracic region is very common with conventional analgesia performed only with opioids, which prolongs recovery, increasing costs and morbidity. Erector spinae plane blockage is a promising technique for the analgesic control in the postoperative period of cardiac surgeries. The purpose of this study was to describe a case in which erector spinae plane blockage provided adequate postoperative analgesic control. CASE REPORT: A 61-year-old male patient submitted to elective cardiac surgery for left ventricular aneurysmectomy and coronary artery bypass grafting. On the first postoperative day presented pain of intensity 8 on the visual analog scale in the left hemithorax. The patient underwent erector spinae plane blockage with a catheter located at T5 guided by ultrasound with a 17G Tuohy needle and injection of 20mL of 0.5% ropivacaine providing important decrease and improvement of pulmonary expansibility. CONCLUSION: Erector spinae plane blockage provided adequate analgesia and was considered a good therapeutic option.

RESUMO JUSTIFICATIVA E OBJETIVOS: A persistência da dor na região torácica no pós-operatório é muito comum com analgesia convencional realizada apenas com opioides, o que prolonga a recuperação, aumentando os gastos e a morbidade. O bloqueio do plano eretor da espinha é uma técnica promissora no controle analgésico no pós-operatório das cirurgias cardíacas. O objetivo deste estudo foi descrever um caso em que o bloqueio do plano eretor da espinha propiciou adequado controle analgésico pós-operatório. RELATO DO CASO: Paciente do sexo masculino, 61 anos, submetido à cirurgia cardíaca eletiva de aneurismectomia do ventrículo esquerdo e revascularização do miocárdio. No primeiro dia de pós-operatório apresentou dor de intensidade 8 pela escala analógica visual em hemitórax esquerdo. Foi submetido ao bloqueio do plano eretor da espinha com cateter locado em T5 guiado por ultrassom com agulha Tuohy 17G e injeção de 20mL de ropivacaína a 0,5%, propiciando importante diminuição e melhora da expansibilidade pulmonar. CONCLUSÃO: O bloqueio do plano eretor da espinha promoveu analgesia adequada, sendo considerado como uma boa opção terapêutica.

Spinal anesthesia increases the frequency of extubation in the operating room and decreases the time of mechanical ventilation after cardiac surgery

Abstract Introduction: The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. Methods: Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. Results: In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). Conclusion: The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.

Spinal Anesthesia Increases the Frequency of Extubation in the Operating Room and Decreases the Time of Mechanical Ventilation after Cardiac Surgery.

INTRODUCTION: The delayed extubation of patients undergoing mechanical ventilation (MV) in the postoperative period of cardiac surgery (CS) is associated with mortality. The adoption of spinal anesthesia (SA) combined with general anesthesia in CS influences the orotracheal intubation time (OIT). This study aims to verify if the adoption of SA reduces the time of MV after CS, compared to general anesthesia (GA) alone. METHODS: Two hundred and seventeen CS patients were divided into two groups. The GA group included 108 patients (age: 56±1 years, 66 males) and the SA group included 109 patients (age: 60±13 years, 55 males). Patients were weaned from MV and, after clinical evaluation, extubated. RESULTS: In the SA group, considering a 13-month period, 24% of the patients were extubated in the operating room (OR), compared to 10% in the GA group (P=0.00). The OIT was lower in the SA group than in the GA group (SA: 4.4±5.9 hours vs. GA: 6.0±5.6 hours, P=0.04). In July/2017, where all surgeries were performed in the GA regimen, only 7.1% of the patients were extubated in the OR. In July/2018, 94% of the surgeries were performed under SA, and 64.7% of the patients were extubated in the OR (P=0.00). The OIT on arrival at the intensive care unit to extubation, comparing July/2017 to July/2018, was 5.3±5.3 hours in the GA group vs. 1.7±3.9 hours in the SA group (P=0.04). CONCLUSION: The adoption of SA in CS increased the frequency of extubations in the OR and decreased OIT and MV time.