[Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy].
OBJECTIVE
Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy.


METHODS
A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques.


RESULTS
A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed.


CONCLUSIONS
PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.
Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Consorcio Hospital General Universitario de Valencia, España. paulac_g@hotmail.com
P
P
Carmona
J
J
Llagunes
I
I
Casanova
E
E
Mateo
S
S
Cánovas
E
E
Martín
J I
JI
Marqués
J J
JJ
Peña
J
J
de Andrés
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D012189:Retrospective Studies; D000077212:Ropivacaine; D000077149:Sevoflurane; D013908:Thoracotomy / Q000379:methods*
D000577:Amides; D000700:Analgesics; D000701:Analgesics, Opioid; D008738:Methyl Ethers; D010880:Piperidines; D000082:Acetaminophen; D000077149:Sevoflurane; D009020:Morphine; D000077212:Ropivacaine; D008012:Lidocaine; D000077208:Remifentanil