Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair : a randomised clinical trial
Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved..
BACKGROUND: Minimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics.
METHODS: Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model.
RESULTS: As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups.
CONCLUSIONS: Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair.
CLINICAL TRIAL REGISTRATION: NCT03743194.
| Errataetall: |
CommentIn: Br J Anaesth. 2023 Aug;131(2):e49-e50. - PMID 37271722 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:130 |
|---|---|
| Enthalten in: |
British journal of anaesthesia - 130(2023), 6 vom: 11. Juni, Seite 786-794 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Alfirevic, Andrej [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Analgesia |
|---|
| Anmerkungen: |
Date Completed 19.05.2023 Date Revised 27.10.2023 published: Print-Electronic ClinicalTrials.gov: NCT03743194 CommentIn: Br J Anaesth. 2023 Aug;131(2):e49-e50. - PMID 37271722 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.bja.2023.02.038 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM355596121 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM355596121 | ||
| 003 | DE-627 | ||
| 005 | 20231226064659.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.bja.2023.02.038 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1185.xml |
| 035 | |a (DE-627)NLM355596121 | ||
| 035 | |a (NLM)37055276 | ||
| 035 | |a (PII)S0007-0912(23)00126-5 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Alfirevic, Andrej |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair |b a randomised clinical trial |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.05.2023 | ||
| 500 | |a Date Revised 27.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03743194 | ||
| 500 | |a CommentIn: Br J Anaesth. 2023 Aug;131(2):e49-e50. - PMID 37271722 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Minimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics | ||
| 520 | |a METHODS: Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model | ||
| 520 | |a RESULTS: As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups | ||
| 520 | |a CONCLUSIONS: Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair | ||
| 520 | |a CLINICAL TRIAL REGISTRATION: NCT03743194 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a analgesia | |
| 650 | 4 | |a cardiac anaesthesia | |
| 650 | 4 | |a fascial muscle plane blocks | |
| 650 | 4 | |a minimally invasive cardiac surgery | |
| 650 | 4 | |a mitral valve repair | |
| 650 | 4 | |a pain | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 650 | 7 | |a Analgesics |2 NLM | |
| 700 | 1 | |a Marciniak, Donn |e verfasserin |4 aut | |
| 700 | 1 | |a Duncan, Andra E |e verfasserin |4 aut | |
| 700 | 1 | |a Kelava, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Yalcin, Esra Kutlu |e verfasserin |4 aut | |
| 700 | 1 | |a Hamadnalla, Hassan |e verfasserin |4 aut | |
| 700 | 1 | |a Pu, Xuan |e verfasserin |4 aut | |
| 700 | 1 | |a Sessler, Daniel I |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Hargrave, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Bustamante, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Gillinov, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Wierup, Per |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Daniel J P |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Turan, Alparslan |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t British journal of anaesthesia |d 1946 |g 130(2023), 6 vom: 11. Juni, Seite 786-794 |w (DE-627)NLM000000310 |x 1471-6771 |7 nnns |
| 773 | 1 | 8 | |g volume:130 |g year:2023 |g number:6 |g day:11 |g month:06 |g pages:786-794 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.bja.2023.02.038 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 130 |j 2023 |e 6 |b 11 |c 06 |h 786-794 | ||