title: Paravertebral block decreases opioid administration without causing hypotension during transapical transcatheter aortic valve implantation.
abstract: Paravertebral block (PVB) is feasible for postoperative analgesia in patients who undergo cardiac surgery with unilateral thoracotomy. Postoperative continuous PVB is as effective as thoracic epidural anesthesia and is less likely to cause hypotension. However, the intraoperative utility and safety of PVB remains unclear. Therefore, the present study was conducted to determine the efficacy and hemodynamic influence of intraoperative paravertebral bolus injection during cardiac surgery. We retrospectively compared intraoperative medication use and blood pressure measurements between patients who underwent transapical transcatheter aortic valve implantation (TA-TAVI) with (PVB group, n = 46) or without (non-PVB group, n = 15) intraoperative PVB. Remifentanil administration was lower by more than 40 % in the PVB group compared with that in the non-PVB group (728 ± 319 µg vs. 1240 ± 488 µg, P < 0.001). The average and variability of intraoperative blood pressure showed no significant differences between groups. The duration of hypotension (blood pressure less than 80 % of baseline) was 25.1 ± 21.5 % and 25.4 ± 18.1 % of the entire anesthesia time in the non-PVB and PVB groups, respectively (P = 0.74). The use of inotropic and vasopressor agents was comparable between groups. Intraoperative paravertebral bolus injection decreased remifentanil administration without causing hypotension during TA-TAVI in hemodynamically unstable patients. This result suggests the intraoperative utility of PVB in cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan. kokitsu@anes.med.osaka-u.ac.jp.
authors.forename: Kenta
authors.initials: K
authors.lastname: Okitsu
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iritakenishi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Imada
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kamibayashi
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Osaka University, 2-2, Yamadaoka, Suita-City, Osaka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Fujino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002316:Cardiotonic Agents; D010880:Piperidines; D014662:Vasoconstrictor Agents; D000077554:Levobupivacaine; D000077208:Remifentanil; D005283:Fentanyl; D002045:Bupivacaine
keywords: Analgesia; Paravertebral block; TAVI; Thoracotomy; Transapical