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Ultrasound Guided PECS II Block in Minimally Invasive Coronary Artery By-pass Grafting

Mona Raafat El Ghamry, Jehan Mohammad Darwish, Atteia Gad Anwar and Yasser Elghoneimy

Background: Minimally invasive cardiac surgery (MICS) is less invasive than sternotomy but associated with significant postoperative pain. Regional analgesia is debatable with risk of bleeding. PECS II block is simple, less invasive technique.

Objective: To evaluate efficacy of Fentanyl IV-PCA alone or when combined with PECS II block for pain control after MICS.

Method: Sixty adult patients ASA II&III undergoing MICS were randomized to PCA group (Fentanyl IV-PCA alone) or PS group (PECS II block with Fentanyl IV-PCA). Outcome variables included postoperative fentanyl consumption (1 year outcome), time to first analgesic request, end expiratory sevoflurane, extubation time, VAS, HR, MBP, ICU stay and complications.

Results: Total fentanyl consumption 12 hours post- extubation was significantly lower in PS group than PCA group (379 ± 48.87, 480 ± 69.1 mcg, respectively; p=0.001*). Significant differences were observed intraoperative and in first six hours postoperative. No significant differences were observed in second six hours postoperative. Time to first analgesic request was significantly prolonged in PCA group (p=0.001*). End expiratory sevoflurane concentration was significantly lower in PS group (p=0.001*). More patients were extubated in OR in PS group with significant short intubation time in ICU (p=0.001*). VAS score was significantly better in PS group in first six hours post-extubation although, it began to increase four hours post-extubation but still significantly better in PS group. Significant increase in HR and MBP in PCA group at skin incision, thoracotomy, on ICU arrival and two hours later was observed. Four hours postoperative they began to increase in PS group but they still significantly lower than that of PCA group. Significant shorter ICU stay with significant lower incidence of complications was observed in PS group.

Conclusion: PECS II block provides effective analgesia in patients undergoing MICS, with less postoperative opioid consumption, better recovery, less adverse effects and shorter ICU stay.