背景：最近的心脏手术围手术期护理指南推荐多模式疼痛管理以减少阿片类药物的使用。我们评估了多模式疼痛管理，包括胸骨旁肋间神经阻滞对需要胸骨切开术和体外循环的冠状动脉旁路移植术（CABG）患者疼痛控制和阿片类药物使用的影响。
方法：回顾性查询2018年至2019年在亨廷顿医院接受CABG的连续患者的病历。根据是否采用包括胸骨旁肋间神经阻滞的术后增强恢复（ERAS）疼痛管理方案，将患者分为2组。结果，包括逗留时间,疼痛评分,和阿片类药物的使用，进行了比较。
结果：住院时间（天数）5.43与5.38（P=.45，平均疼痛评分2.23vs.ERAS和非ERAS组患者为3.27（P=0.137）。最大疼痛评分,7.74至6.15（P=.015），和阿片类药物的使用（总吗啡毫克当量），149.64至32.01（P<.01），在ERAS组中减少。
结论：使用术中胸骨旁阻滞的ERAS多模式疼痛管理方案似乎可减轻CABG术后疼痛并减少阿片类药物的使用。
BACKGROUND: Recent guidelines for perioperative care in cardiac surgery recommend multimodal pain management to decrease opioid use. We evaluated the effect of multimodal pain management including parasternal intercostal nerve block on pain control and opioid use in patients who underwent coronary artery bypass grafting (CABG) requiring sternotomy and cardiopulmonary bypass.
METHODS: Medical records of consecutive patients who underwent CABG from 2018 to 2019 at Huntington Hospital were retrospectively queried. Patients were divided in 2 groups based on whether an Enhanced Recovery After Surgery (ERAS) pain management protocol including parasternal intercostal nerve blocks was employed. Outcomes, including length of stay, pain scores, and opioid use, were compared.
RESULTS: There was no difference in length of stay (days) 5.43 vs. 5.38 (P = .45 and average pain score 2.23 vs. 3.27 (P = .137) for patients in the ERAS and non-ERAS groups. Maximum pain score, 7.74 to 6.15 (P = .015), and opioid use (total morphine mg equivalent), 149.64 to 32.01 (P < .01), were reduced in the ERAS group.
CONCLUSIONS: The ERAS multimodal pain management protocol utilizing intraoperative parasternal blocks appears to reduce pain and decrease opioid use after CABG.
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