ASA Abstract Reviews
Pain Management After Atrial Septal Defect Closure by the Lateral Thoracic Approach Using Continuous Retrolaminar Block
Tomohiro Chaki, MD, Yuko Nawa, MD,Ph.D., Keishi Tamashiro, MD, Michiaki Yamakage, MD, PhD
Sapporo Medical University School of Medicine, Sapporo, Japan
(Summarized and submitted by Tomohiro Chaki, MD)
The retrolaminar block (RLB) is relatively new analgesic technique for postoperative pain following unilateral thoracic and abdominal surgery. This blockade firstly reported in 2011 (1) and has been used for various operation (2,3). The lateral thoracic approach for open heart surgery has gradually become popular from a cosmetic perspective. This approach tends to be used in children to make the scar inconspicuous.
Thoracic surgery causes severe postoperative pain, but the application of neuraxial blocks is difficult because of heparinization for cardiopulmonary bypass. Paravertebral block is a useful alternative analgesic method for lateral thoracotomy, although one of the serious complications of this block is pneumothorax which may be life-threatening, especially under positive pressure ventilation. In our study, RLB was applied for analgesia following atrial septal defect closure via the lateral thoracic approach in children and assessed the efficacy of RLB for postoperative pain management. We conducted prospective, observational study and assessed 15 patients aged 6 – 20 years and underwent elective ASD closure via the lateral thoracic approach. After general anesthesia induction, patients were placed in the left lateral position and the catheter for RLB was placed in 1 – 1.5 cm lateral line from median at the Th5 or 6 level. At the end of surgery, 10 mL of 0.375% ropivacaine was injected and 0.2% ropivacaine was commenced at the rate of 4 mL/hr. Postoperative pain score was recorded every 8 hours using Wong-Baker’s face scale and the number of rescues with NSAID per day was also recorded. The pain score peaked at 40 – 48 hours after surgery (2 [1 – 4]) and the peak number of rescue NSAID was observed on postoperative day 1 (1[0 – 2]). There was no severe postoperative adverse event associated with RLB.
We applied RLB for postoperative analgesia after ASD closure using the lateral thoracic approach and the peak pain score indicated an intermediate pain level. Comparing with past reports, the efficacy of RLB is equivalent to those of rectus sheath block. If this RLB is applied to small children, one of the problems of this RLB is local anesthetic toxicity. In our study, the serum concentration of ropivacaine was not measured. Patients expressed the symptom of local anesthetic toxicity, but the study which measuring the serum concentration of local anesthetic is mandatory to reveal the safety of RLB. The significant merit of RLB is the necessity of easy technique and the avoidance of pneumothorax and epidural hematoma caused by paravertebral block and epidural block, respectively. From this point of view, RLB has potency to become alternative analgesic method for ASD closure via the lateral thoracic approach and we suggest that this RLB should be applied various thoracic and abdominal truncal block in especially children.
References
- Jüttner T, Werdehausen R, Hermanns H, et al. The paravertebral lamina technique: a new regional anesthesia approach for breast surgery. J Clin Anesth. 2011;23:443-50
- Ueshima H, Hara E, Otake H. Lumbar vertebra surgery performed with a bilateral retrolaminar block. J Clin Anesth. 2017;37:114
- Ueshima H, Hiroshi O. Transapical transcatheter aortic valve implantation performed with a retrolaminar block. J Clin Anesth. 2016;35:274
