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The Impact of Continuous Thoracic Paravertebral Block on the Rate of Post-Operative Atrial Fibrillations after Minimally Invasive Cardiac Surgery: A Propensity-Score-Matched Analysis
Author(s): ,
Shibata, S.*
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
,
Maeda, A.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
,
Taenaka, H.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
,
Imada, T.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
,
Iritakenishi, T.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
,
Okitsu, K.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
Fujino, Y.
Affiliations:
Osaka University Graduate School of Medicine, Department of Anaesthesiology and Intensive Care, Suita- Osaka, Japan
ESRA Academy. Shibata S. Sep 13, 2017; 190997; 534
Dr. Sho Shibata
Dr. Sho Shibata

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Abstract
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Background and Aims:

Postoperative atrial fibrillation(POAF) frequently occurs after cardiovascular surgery and has been related to increased morbidity and mortality. Increased post-operative pain and sympathetic tone are some of the many factors contributing to the development of POAFs.The effect of continuous thoracic paravertebral block (TPVB) on the prevention of POAFs after minimally invasive cardiac surgery for mitral valve repair (MICS-MVR) has not been well studied. We hypothesized a TPVB could provide a protective effect against the onset of POAFs as seen in epidural anesthesia after cardiac surgery.

Methods:

We designed a propensity score-based matched retrospective study at our center.The occurrence of POAF was defined as the persistence of atrial fibrillation for at least 1hr. Ninety-five consecutive patients were assessed and 78 patients were grouped to either, the continuous TPVB group (continuous TPVB with general anesthesia [GA]; n=54) or the no-TPVB group (GA alone; n=24). Ultrasound guided unilateral right side catheter placement was done prior to surgery for patients in the continuous TPVB group. A propensity-score based matching between groups with a 1:1 ratio was performed. The matching yielded a final cohort of 38 patients for the primary outcome analysis. 

Results:

Continuous TPVB group had significantly lower rates of POAF than the no-TPVB group, 15.8% versus 52.6%, respectively. (Odds ratio 0.169; 95% confidence interval 0.037-0.777, p=0.022) However, TPVB did not significantly reduce in the mean 24-hr postoperative morphine equivalent consumption or the time to extubation. There were no complications related to the use of TPVB.

Conclusions:

Continuous TPVB reduced the occurrence of POAFs in patients undergoing MICS-MVR.

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