Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report.","authors":"Yacine Ynineb,&nbsp;Emilie Boglietto,&nbsp;Francis Bonnet,&nbsp;Christophe Quesnel,&nbsp;Marc Garnier","doi":"10.1177/10892532211007664","DOIUrl":"https://doi.org/10.1177/10892532211007664","url":null,"abstract":"<p><p>Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"90-94"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211007664","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25578316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroid Administration and Impaired Glycemic Control in Mechanically Ventilated COVID-19 Patients.","authors":"David J Douin,&nbsp;Martin Krause,&nbsp;Cynthia Williams,&nbsp;Kenji Tanabe,&nbsp;Ana Fernandez-Bustamante,&nbsp;Aurora N Quaye,&nbsp;Adit A Ginde,&nbsp;Karsten Bartels","doi":"10.1177/10892532211043313","DOIUrl":"https://doi.org/10.1177/10892532211043313","url":null,"abstract":"<p><strong>Objective: </strong>Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Design: </strong>Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission.</p><p><strong>Setting: </strong>Twelve hospitals in a United States health system.</p><p><strong>Patients: </strong>Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"32-40"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927893/pdf/10.1177_10892532211043313.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39374958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Anesthesiology - Paving the Way across Multiple Subspecialties.","authors":"Benjamin Abrams,&nbsp;Markus Kowalsky,&nbsp;Nathaen Weitzel,&nbsp;Miklos D Kertai","doi":"10.1177/10892532221076655","DOIUrl":"https://doi.org/10.1177/10892532221076655","url":null,"abstract":"Specialists in cardiothoracic and abdominal transplant anesthesia offer unique expertise and a vast breadth of knowledge that contribute to the management of these notably complex patients. Furthermore, these contributions extend beyond intraoperative management, to include leadership throughout the perioperative period, critical care medicine, and even global health. This issue of Seminars in Cardiothoracic and Vascular Anesthesia highlights this broad spectrum of expertise through original research, review articles, and case reports, spanning topics as diverse as airway management, coagulopathy, pediatric heart failure, echocardiography, and educational milestones for fellowship training for abdominal transplant. In the first article of the Original Research section, Auci et al present a retrospective, single-center, observational trial evaluating the optimal time to assess platelet dysfunction during cardiac surgery through the use of platelet aggregometry. In this trial of 63 patients, they utilized an adenosine-50-diphosphate (ADP)-test to compare platelet function at four separate time periods (baseline, aortic declamping, 10 minutes after protamine administration, and end of surgery). There were statistically significant differences in ADP-test results between almost all time periods, with one notable exception: aortic de-clamping vs 10 minutes following protamine. Clinically, this study demonstrates potential value in early identification of platelet dysfunction through assessment at the time of aortic de-clamping, thus allowing timely recognition and thus more effective treatment of platelet impairment following cardiopulmonary bypass (CPB). Anesthesiologists play an essential role for teams performing congenital cardiac surgery in resource-poor conditions throughout the world. To better characterize this work with the goal of improving participation and directing resources, Hubbard et al surveyed members of the Congenital Cardiac Anesthesia Society (CCAS). Survey participants (n = 108) reported 115 total trips to 41 countries spanning 5 continents. The survey covered a broad range of topics, including the nature of the work, trends in geographic locations, and factors that may influence an anesthesiologist’s participation in these efforts. Notably, many of the barriers that interested individuals reported facing stemmed from a lack of institutional support. Not surprisingly, there was also a sharp decline in participation for the year 2020 due to pandemicrelated factors, generating a backlog of cases and further expanding the need for participation in this work in the years to come. With the understanding of dexamethasone’s benefits in treating severe COVID-19 infections, Douin et al performed a multicenter retrospective cohort study to investigate the association between corticosteroid administration and impaired glycemic control in critically ill COVID-19 patients. The study included 292 patients from 12 centers in the United States w","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"5-7"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39914027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unanticipated Profound Paralysis and Sugammadex Dosing Implications After Videoscopic Thoracic Surgery.","authors":"Melissa L McKittrick,&nbsp;Frederick W Lombard","doi":"10.1177/10892532211059885","DOIUrl":"https://doi.org/10.1177/10892532211059885","url":null,"abstract":"<p><p>A bedridden patient with empyema presented for thoracoscopic decortication. During the procedure, despite a post-tetanic count (PTC) of 0 via calibrated quantitative neuromuscular monitoring, persistent diaphragmatic movement impaired operating conditions, so rocuronium was re-dosed. After surgery, the patient had 0 PTC. Sugammadex was titrated to achieve baseline neuromuscular strength, monitoring the effect of each 200-mg dose. Ultimately, 1200 mg was required to achieve baseline strength. We describe monitor troubleshooting, considerations with unexpectedly deep neuromuscular blockade, the importance of routine quantitative neuromuscular monitoring, and one strategy for sugammadex reversal in patients with profound paralysis outside of the standard dosing guidelines.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"26 1","pages":"86-89"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39800998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is It Time for Paradigm Shift in Pain Management for Cardiac Surgery Patients?","authors":"Kathirvel Subramaniam,&nbsp;Ibrahim Sultan,&nbsp;Nathaen Weitzel,&nbsp;Miklos D Kertai","doi":"10.1177/10892532211058494","DOIUrl":"https://doi.org/10.1177/10892532211058494","url":null,"abstract":"Opioids are reliable and effective analgesics for treating acute postoperative pain following any surgical procedure, including cardiac surgery. Recent concerns about persistent opioid use after discharge from the hospital have triggered changes in the way patients’ pain is managed during their perioperative period. This has led to the widespread use of various regional analgesic techniques, as well as anesthesia techniques based on non-narcotic analgesics for cardiac surgery. Multi-modal analgesia has been an accepted component of enhanced recovery after surgery (ERAS) protocols and implementation of ERAS in cardiac surgery has been shown to decrease opioid consumption, duration of mechanical ventilation, and length of intensive care unit and hospital stay. Seminars in Cardiothoracic and Vascular Anesthesia (SCVA) invited submissions related to painmanagement after cardiac surgery and published a series of impressive articles dedicated to this important topic for the December issue. Devarajan et al explored evidence behind the use of various neuraxial and non-neuraxial regional analgesic techniques in a two-part review. It is clear that epidural blocks will not be re-entering the cardiac surgical arena because of concerns over epidural hematoma, despite their advantages. However, spinal opioids are making a comeback, with renewed interest in their clinical use and research for ERAS protocols. Tissue plane blocks (erector spinae block, pecto-intercostal block, and transverse thoracic plane block) are becoming popular, as they can be administered easily with ultrasound guidance and have been found to be safe compared to central neuraxial blocks in cardiac surgery. In this issue of SCVA, two original articles are published on the use of these tissue plane blocks in cardiothoracic surgery. Cardinale et al studied transverse thoracic plane blocks in elective cardiac surgery along with multimodal analgesia. The authors reported increased early extubations and shortened length of intensive care unit and hospital stay. Dunham et al published on the utility of intercostal nerve blocks with standard and liposomal bupivacaine in thoracic surgical patients. While these studies add evidence to support the incorporation of these blocks into clinical practice, there is a need for large, well-controlled, and randomized clinical studies with meaningful patient outcomes before perioperative physicians can declare victory and adopt them into a new standard of care. The use of various non–opioid-based analgesics (ketamine, dexmedetomidine, lidocaine, acetaminophen, ketorolac, and gabapentin) in cardiac surgery is another topic of debate. Nazarnia et al reviewed and reported the evidence behind the use of non–opioid-based analgesics in cardiac surgery practice. While the cardiac anesthesia community has widely adopted the use of these medications as alternatives to opioids, the review pointed out the lack of clear evidence supporting the efficacy and safety of many ","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"249-251"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39721110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery.","authors":"Jagan Devarajan,&nbsp;Sennaraj Balasubramanian,&nbsp;Soheyla Nazarnia,&nbsp;Charles Lin,&nbsp;Kathirvel Subramaniam","doi":"10.1177/10892532211023337","DOIUrl":"https://doi.org/10.1177/10892532211023337","url":null,"abstract":"<p><p>Cardiac surgeries are known to produce moderate to severe pain. Pain management has traditionally been based on intravenous opioids. Poorly controlled pain can result in increased incidence of respiratory complications such as atelectasis and pneumonia leading to prolonged intubation and intensive care unit length of stay and subsequent prolonged hospital stay. Adequate perioperative analgesia improves hemodynamics and immunologic responses, which would result in better outcomes after cardiac surgery. Opioid sparing \"Enhanced Recovery After Surgery\" protocols are increasingly being incorporated into cardiac surgeries. This will reduce opioid requirements and opioid-related side effects and facilitate fast-tracking of patients. Regional analgesia can be provided by neuraxial blocks, fascial plane blocks, peripheral nerve blocks, or simply by the infiltration of the wound with local anesthetics for cardiac surgery. Neuraxial analgesia is provided through epidural, spinal, and paravertebral routes. Though they are being replaced by peripheral fascial plane blocks, epidural and spinal analgesia are still being used in some centers. In this article, neuraxial forms of analgesia are focused. We sought to review epidural analgesia and its impact in suppressing hemodynamic stress response, reducing pulmonary complications, and development of chronic pain. The relationship between intraoperative heparinization and potential neuraxial hematoma is discussed. Other neuraxial options such as spinal and paravertebral analgesia and their usefulness, benefits, and limitations are also reviewed.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"252-264"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10892532211023337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39119214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Pain After Cardiac Surgery: Prevention and Management.","authors":"James C Krakowski,&nbsp;Matthew J Hallman,&nbsp;Alan M Smeltz","doi":"10.1177/10892532211041320","DOIUrl":"https://doi.org/10.1177/10892532211041320","url":null,"abstract":"<p><p>Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"289-300"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39330455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporation of the Transverse Thoracic Plane Block Into a Multimodal Early Extubation Protocol for Cardiac Surgical Patients.","authors":"Jeffrey P Cardinale,&nbsp;Ryan Latimer,&nbsp;Candace Curtis,&nbsp;Yana Bukovskaya,&nbsp;Logan Kosarek,&nbsp;Jason Falterman,&nbsp;Danielle M Tatum,&nbsp;Jay Trusheim","doi":"10.1177/1089253220957484","DOIUrl":"https://doi.org/10.1177/1089253220957484","url":null,"abstract":"<p><strong>Background: </strong>The aim for early extubation remains an important goal in cardiac surgical patients. Therefore, employment of a multimodal approach to pain management that includes a transverse thoracic plane block was retrospectively examined at a single-center tertiary care hospital on the effects of time to extubation, opioid consumption, and length of stay in patients undergoing cardiac surgery via median sternotomy.</p><p><strong>Methods: </strong>Blocks were performed on all cardiac surgical patients except for those undergoing left ventricular assist device placement, thoracic transplant, emergent surgery, or redo sternotomy. Following additional exclusions for intra- and postoperative complications unrelated to anesthesia, final analysis was conducted on 75 patients per group. Multimodal pain management included intravenous analgesics and transverse thoracic plane block where patients received 15 mL 0.5% bupivacaine + epinephrine bilaterally under ultrasound guidance prior to incision.</p><p><strong>Results: </strong>Following transverse thoracic plane block and multimodal analgesics, 50.6% of patients were extubated in the operation room versus 8.6% in the control group. Intraoperative opioids were decreased, and intensive care unit and total length of stay were reduced by 5 hours and 1 day, respectively, in block patients as compared with controls. Postoperative opioids were not significantly different. There were no reported complications directly attributed to the block.</p><p><strong>Conclusions: </strong>The transverse thoracic plane block and multimodal regimen for patients undergoing median sternotomy resulted in a significant number of patients extubated in the operation room without an increase in postoperative re-intubations. Moreover, the block appears to be a quick and safe procedure to utilize on cardiac surgery patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"301-309"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253220957484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38361082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Current Status of Neuraxial and Paravertebral Blocks for Adult Cardiac Surgery\".","authors":"","doi":"10.1177/10892532211065082","DOIUrl":"https://doi.org/10.1177/10892532211065082","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"324"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39577810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Regional Analgesia Techniques on Opioid Consumption and Length of Stay After Thoracic Surgery.","authors":"Wills C Dunham,&nbsp;Frederick W Lombard,&nbsp;David A Edwards,&nbsp;Yaping Shi,&nbsp;Matthew S Shotwell,&nbsp;Kara Siegrist,&nbsp;Susan S Eagle,&nbsp;Mias Pretorius,&nbsp;Matthew D McEvoy,&nbsp;Erin A Gillaspie,&nbsp;Jonathan C Nesbitt,&nbsp;Jonathan P Wanderer,&nbsp;Miklos D Kertai","doi":"10.1177/1089253220949434","DOIUrl":"https://doi.org/10.1177/1089253220949434","url":null,"abstract":"<p><strong>Background: </strong>We examined how intercostal nerve block (ICNB) with standard bupivacaine and ICNB with extended-release liposomal bupivacaine, compared with thoracic epidural analgesia (TEA), were associated with postoperative opioid pain medication consumption and hospital length of stay (LOS) after thoracic surgery.</p><p><strong>Methods: </strong>We studied 1935 patients who underwent thoracic surgery between January 1, 2010, and November 30, 2017, at a tertiary academic center. Primary and secondary outcomes were postoperative opioid consumption expressed as morphine milligram equivalents (MMEs) at 24, 48, and 72 hours after surgery, the LOS, and total MME consumption from surgery to discharge.</p><p><strong>Results: </strong>Of these patients, 888 (45.9%) received TEA, 730 (37.7%) ICNB with standard bupivacaine, 127 (6.6%) ICNB with liposomal bupivacaine, and 190 (9.8%) no regional analgesia. Compared with epidural analgesia, in 2017, ICNB liposomal bupivacaine provided similar pain control in terms of MME consumption at 24 and 72 hours, but decreased MME consumption at 48 hours (odds ratio [OR] = 0.33; confidence interval [CI] = 0.14-0.81) and at discharge (OR = 0.28; CI = 0.12-0.68) and was associated with a higher likelihood for a shorter LOS (hazard ratio = 3.46; CI = 2.42-4.96). Compared with TEA, ICNB with standard bupivacaine and no regional analgesia use showed varying impact on MME consumption between 24 and 72 hours after surgery, and their use was not associated with a significantly reduced MME consumption at discharge but with a shorter hospital LOS.</p><p><strong>Conclusions: </strong>Multimodal analgesia involving regional anesthetic alternatives to TEA could help manage postoperative pain in thoracic surgery patients.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":"25 4","pages":"310-323"},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1089253220949434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38489764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}