• Andrej Alfirevic, Donn Marciniak, Andra E Duncan, Marta Kelava, Esra Kutlu Yalcin, Hassan Hamadnalla, Xuan Pu, Daniel I Sessler, Andrew Bauer, Jennifer Hargrave, Sergio Bustamante, Marc Gillinov, Per Wierup, Daniel J P Burns, Louis Lam, and Alparslan Turan.
• Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: alfirea@ccf.org.
• Br J Anaesth. 2023 Jun 1; 130 (6): 786794786-794.

BackgroundMinimally 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.MethodsAdults 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.ResultsAs 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.ConclusionsSerratus 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 RegistrationNCT03743194.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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