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Imaging evaluation of continuous extrapleural intercostal nerve block for minimally invasive cardiac surgery: a case
Misa Terauchi1, Hiroai Okutani2, Daisuke Ishimoto1
1Department of Anesthesiology and Pain Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
Background:
Spinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization. Continuous extrapleural intercostal nerve block (CEINB) is a postoperative pain treatment for intercostal thoracotomy, with fewer complications. Here, we report a case in which imaging evaluation of CEINB with contrast medium was conducted to anatomically confirm the spread of local anesthetics after MICS.
Case Presentation:
A 65-year-old woman with severe mitral regurgitation underwent mitral valve plasty under general anesthesia via right-sided mini-thoracotomy. A CEINB catheter was placed before the incision was closed, without creating a conventional extrapleural pocket. We conducted an imaging evaluation with a contrast medium via the inserted catheter and confirmed sufficient spread around the intercostal nerve area. In addition, postoperative pain was well controlled by the nerve block.
Conclusions:
Imaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS.
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