title: A Prospective Randomized Study of Paravertebral Blockade in Patients Undergoing Robotic Mitral Valve Repair.
abstract: OBJECTIVE
  The aim of this study was to evaluate the addition of paravertebral blockade to general anesthesia in patients undergoing robotic mitral valve repair.
  
  
  METHODS
  A randomized, prospective trial.
  
  
  METHODS
  A single tertiary referral academic medical center.
  
  
  METHODS
  60 patients undergoing robotic mitral valve surgery.
  
  
  METHODS
  Patients were randomized to receive 4-level paravertebral blockade with 0.5% bupivicaine before induction of general anesthesia. All patients were given a fentanyl patient-controlled analgesia upon arrival to the intensive care unit, and visual analog scale pain scores were queried for 24 hours. On postoperative day 2, patients were given an anesthesia satisfaction survey.
  
  
  RESULTS
  After obtaining institutional review board approval, surgical and anesthetic data were recorded perioperatively and compared between groups. Compared to general anesthesia alone, patients receiving paravertebral blockade and general anesthesia reported significantly less postoperative pain and required fewer narcotics intraoperatively and postoperatively. Patients receiving paravertebral blockade also reported significantly higher satisfaction with anesthesia. Successful extubation in the operating room at the conclusion of surgery was 90% and similar in both groups. Hospital length of stay also was similar. No adverse reactions were reported.
  
  
  CONCLUSIONS
  The addition of paravertebral blockade to general anesthesia appears safe and can reduce postoperative pain and narcotic usage in patients undergoing minimally invasive cardiac surgery. These findings were similar to previous studies of patients undergoing thoracic procedures. Paravertebral blockade alone likely does not reduce hospital length of stay. This may be more closely related to early extubation, which is possible with or without paravertebral blockade.
authors.affiliation: Department of Anesthesiology. Electronic address: peter.neuburger@nyumc.org.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neuburger
authors.affiliation: Department of Anesthesiology.
authors.forename: Jennie Y
authors.initials: JY
authors.lastname: Ngai
authors.affiliation: Department of Anesthesiology.
authors.forename: M Megan
authors.initials: MM
authors.lastname: Chacon
authors.affiliation: Department of Anesthesiology.
authors.forename: Brent
authors.initials: B
authors.lastname: Luria
authors.affiliation: Department of Anesthesiology.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Manrique-Espinel
authors.affiliation: Department of Anesthesiology.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Kline
authors.affiliation: Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.affiliation: Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York.
authors.forename: Didier F
authors.initials: DF
authors.lastname: Loulmet
mesh_terms: D000368:Aged; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D014463:Ultrasonography
keywords: minimally invasive cardiac surgery; mitral valve repair; paravertebral block; regional anesthesia; robotic