Journal of cardiothoracic and vascular anesthesia · 2025
Deep Parasternal Intercostal Plane Blocks and Their Role in a Cardiac Fast-Track Program.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zabida Amir, Foley Karen, Gonzalez Cristopher Araya, Chaverra Santiago, Esteban Margarita Otalora, Senniappan Kirubanand, Díaz Paola Vidal, Segura-Salguero Juan Camilo, Ansari Bilal, Kahn Michael, Rao Vivek, Djaiani George
Аннотация
OBJECTIVES: To determine if deep parasternal intercostal plane (DPIP) blocks are associated with reduced opioid consumption and a subsequent reduction in postoperative delirium after cardiac surgery.
DESIGN: A retrospective observational study.
SETTING: A single-center tertiary care hospital.
PARTICIPANTS: Three hundred and eight adult patients who underwent cardiac surgery with median sternotomy between March 2021 and February 2023.
INTERVENTIONS: DPIP blocks are performed after chest closure in the operating room under sterile conditions and with real-time ultrasound guidance. The control group did not receive DPIP blocks.
MEASUREMENTS AND MAIN RESULTS: Median [range] postoperative hydromorphone consumption at 12 hours was 0.8 [0-2.6] mg vs. 1.2 [0-2.6] mg, p = 0.0004, and at 24 hours was 0.4 [0-3.2] mg versus 0.6 [0-3.4] mg, p = 0.007 in the DPIP and control groups, respectively. Predictors of reduced hydromorphone requirements included the presence of DPIP blocks, use of a dexmedetomidine infusion, and absence of composite comorbidities. Postoperative delirium was present in 17 (11%) and 23 (14.9%) patients in the DPIP block and control groups respectively (odds ratio 0.76; 95% confidence interval 0.38-1.53, p = 0.45). The median [IQR] time to extubation was 135 [65, 274] minutes versus 196.5 [74, 420] minutes in the DPIP and control groups, respectively, p = 0.04. There was no difference with respect to major morbidity and mortality between the two groups.
CONCLUSIONS: DPIP blocks were associated with decreased perioperative opioid consumption, and earlier tracheal extubation after cardiac surgery. DPIP blocks may be incorporated within the fast-track cardiac anesthesia pathways; however, alternative strategies need to be further explored to reduce postoperative delirium after cardiac surgery.
DESIGN: A retrospective observational study.
SETTING: A single-center tertiary care hospital.
PARTICIPANTS: Three hundred and eight adult patients who underwent cardiac surgery with median sternotomy between March 2021 and February 2023.
INTERVENTIONS: DPIP blocks are performed after chest closure in the operating room under sterile conditions and with real-time ultrasound guidance. The control group did not receive DPIP blocks.
MEASUREMENTS AND MAIN RESULTS: Median [range] postoperative hydromorphone consumption at 12 hours was 0.8 [0-2.6] mg vs. 1.2 [0-2.6] mg, p = 0.0004, and at 24 hours was 0.4 [0-3.2] mg versus 0.6 [0-3.4] mg, p = 0.007 in the DPIP and control groups, respectively. Predictors of reduced hydromorphone requirements included the presence of DPIP blocks, use of a dexmedetomidine infusion, and absence of composite comorbidities. Postoperative delirium was present in 17 (11%) and 23 (14.9%) patients in the DPIP block and control groups respectively (odds ratio 0.76; 95% confidence interval 0.38-1.53, p = 0.45). The median [IQR] time to extubation was 135 [65, 274] minutes versus 196.5 [74, 420] minutes in the DPIP and control groups, respectively, p = 0.04. There was no difference with respect to major morbidity and mortality between the two groups.
CONCLUSIONS: DPIP blocks were associated with decreased perioperative opioid consumption, and earlier tracheal extubation after cardiac surgery. DPIP blocks may be incorporated within the fast-track cardiac anesthesia pathways; however, alternative strategies need to be further explored to reduce postoperative delirium after cardiac surgery.