Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2019
Early Versus Late Paravertebral Block for Analgesia in Video-Assisted Thoracoscopic Lung Resection. A Double-Blind, Randomized, Placebo-Controlled Trial.
Paravertebral local analgesia is effective in providing pain relief after video assisted thoracoscopic surgery. This randomized, double-blind pilot clinical trial investigated the effect of early perioperative delivery of paravertebral local analgesia to reduce postoperative pain after video assisted thoracoscopic lung resection and the feasibility of a larger trial. ⋯ The authors found no difference in acute postoperative pain, but the decrease in morphine consumption and prevalence of chronic pain with early paravertebral bupivacaine, although not statistically significant, may warrant further investigation with a larger trial.
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J. Cardiothorac. Vasc. Anesth. · Feb 2019
Randomized Controlled Trial Multicenter StudyDouble-Blind, Randomized, Placebo-Controlled Trial Comparing the Effects of Antithrombin Versus Placebo on the Coagulation System in Infants with Low Antithrombin Undergoing Congenital Cardiac Surgery.
To determine whether precardiopulmonary bypass (CPB) normalization of antithrombin levels in infants to 100% improves heparin sensitivity and anticoagulation during CPB and has beneficial effects into the postoperative period. ⋯ Supplementation of antithrombin in infants with low antithrombin levels improves heparin sensitivity and anticoagulation during CPB without increased rates of bleeding or adverse events. Beneficial effects may be seen into the postoperative period, reflected by significantly less postoperative bleeding and exposure to blood products and reduced generation of D-dimers.
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J. Cardiothorac. Vasc. Anesth. · Feb 2019
Randomized Controlled TrialContinuous Ropivacaine Infusion Offers No Benefit in Treating Postoperative Pain After Cardiac Surgery.
One multimodal pain management method for reducing postoperative opioid need after cardiac surgery is to continuously infuse local anesthetic into a median sternotomy wound. Previous studies have shown contradictory results with this method; therefore, no consensus exists on its effectiveness. The authors tested the effectiveness of continuous 0.2% ropivacaine infusion into a sternotomy wound after cardiac surgery. ⋯ Continuous 0.2% ropivacaine infusions at the median sternotomy wound did not reduce postoperative pain or opioid consumption during the first 48 hours after cardiac surgery. This technique apparently was not beneficial for post-sternotomy pain treatment.
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J. Cardiothorac. Vasc. Anesth. · Feb 2019
Editorial CommentPreemptive Analgesia: An Unobtainable Goal?