Continuous Percutaneous Paravertebral Block for Minimally Invasive Cardiac Surgery

摘要: p OSTOPERATIVE PAIN after thoracotomy is managed by a number of modalities, including thoracic epidural analgesia (TEA), intercostal block (ICB), interpleural block, and paravertebral b l o c k y Although most regional blocks need to be inserted before surgery, Sabanathan et aP have described technique stripping the pleura posteriorly via surgical incision position catheter in space for infusion local anesthetics. This technique, some studies, has been documented as good TEA, latter being gold standard postthoracotomy analgesia.1 Minimally invasive direct coronary artery bypass graft surgery (MIDCABG) without aid cardiopulmonary (CPB) performed more frequently using minithoracotomy. In authors' institution, patients come "same day admit" on morning surgery. These are extubated operating table at end anesthesia discharged home 48 72 hours later. To optimize benefits from such fast-tracking, titrated. The authors currently evaluating TEA MIDCABG comparing it with continuous ICB surgeon al. 3 It difficult strip parietal adequately through small anterior insert far enough closer area (Fig 1). Because initiated only this group, compared required higher doses intraoperative fentanyl (TEA = 269 _+ 120 ~g v 1,160 + 539 pg), nitroglycerin 4,089 -+ 2,863 pg 7,953 5,174 ~tg), morphine 0 6.3 5.8 mg) 6 well requiring end-tidal concentrations isoflurane achieve hemodynamic control during intense stimulation associated thoracotomy. All these factors may contribute postoperative ventilation. view experience, believe that insertion facilitate early extubation. Rather than infusion, multiple injections T1 T8 used breast 4 which encompasses similar dermatomal segment minithoracotomy MIDCABG. Single inadequate 24 36 hours' duration article reports use percntaneously just pain relief