Evaluation of Liposomal Bupivacaine Compared to Usual Care and Its Effects on Pain for Cardiac Surgery

2019 ◽  
Author(s):  
Keyword(s):  
Cardiac Surgery ◽  
Usual Care ◽  
Liposomal Bupivacaine

Liposomal bupivacaine infiltration after median sternotomy incision in pediatric cardiac surgery

2021 ◽  
Author(s):  
Christopher F. Tirotta ◽  
Richard G. Lagueruela ◽  
Daria Salyakina ◽  
Apeksha Gupta ◽  
Frank Alonso ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Median Sternotomy ◽  
Pediatric Cardiac Surgery ◽  
Liposomal Bupivacaine

A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass

2016 ◽  
Vol 125 (3) ◽  
pp. 465-473 ◽  
Author(s):  
Shay P. McGuinness ◽  
Rachael L. Parke ◽  
Kate Drummond ◽  
Tim Willcox ◽  
Michael Bailey ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Length Of Stay ◽  
Usual Care ◽  
Organ Damage ◽  
Controlled Study ◽  
Multiorgan Dysfunction ◽  
Randomized Controlled

Abstract Background Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery–associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels. This study aimed to determine whether the avoidance of arterial hyperoxemia decreased oxidative stress and reduced the severity of the multiorgan dysfunction in patients undergoing cardiac surgery utilizing CPB. Methods The study was a multicenter, open-label, parallel-group, randomized controlled study of the avoidance of arterial hyperoxemia versus usual care in patients undergoing cardiac surgery involving CPB. Primary outcome was the incidence and severity of AKI. Secondary outcomes included serum biomarkers for CSA-MOD, duration of mechanical ventilation, and length of intensive care and hospital stay. Results A total of 298 patients were randomized and analyzed at two hospitals in New Zealand and Australia. Mean Pao2 was significantly different between groups during CPB. There was no difference in the development of AKI (intervention arm 72.0% vs. usual care 66.2%; difference, −5.8% [95% CI, −16.1 to 4.7%]; P = 0.28), other markers of organ damage, or intensive care unit and hospital length of stay. Conclusions Avoiding modest hyperoxemia during CPB failed to demonstrate any difference in AKI, markers of organ damage, or length of stay.

Liposomal Bupivacaine–Based Erector Spinae Block for Cardiac Surgery

2020 ◽  
Author(s):  
Kaicheng Song ◽  
Qian Xu ◽  
Victoria H. Knott ◽  
Chen B. Zhao ◽  
Sean P. Clifford ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Erector Spinae ◽  
Liposomal Bupivacaine

Impact of intraoperative methadone use on postoperative opioid requirements after cardiac surgery

2021 ◽  
Author(s):  
David J Wang ◽  
Pingping Song ◽  
Katharine M Nault
Keyword(s):  
Cardiac Surgery ◽  
Usual Care ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Bypass Graft ◽  
Oral Morphine ◽  
Hospital Length Of Stay ◽  
Short Acting ◽  
Pain Scores ◽  
Valvular Surgery

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Inadequate pain control after cardiac surgery increases postoperative morbidity. Increasing evidence suggests that perioperative intravenous (IV) methadone results in improved analgesia. This study evaluated the effect of intraoperative IV methadone on postoperative opioid requirements and surgical recovery. Methods A retrospective review of patients undergoing coronary artery bypass graft (CABG), valvular surgery or both between April 2017 and August 2018 was conducted. Patients were separated into a usual care cohort of those who received short-acting opioids (ie, IV fentanyl, hydromorphone, or morphine) alone or a methadone cohort of those who received IV methadone plus short-acting opioids. Opioid requirements were assessed within the first 24 hours of surgery (postoperative day [POD] 0) and 25 to 48 hours after surgery (POD 1) as oral morphine milligram equivalents (MME). Postoperative pain scores, adjunctive analgesia, time to extubation, use of noninvasive respiratory support (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]), and intensive care unit (ICU) and hospital length of stay (LOS) were also evaluated. Results A total of 117 patients were evaluated (methadone cohort, n = 52; usual care cohort, n = 65). Median cumulative intraoperative opioid consumption was less in the methadone cohort (150 MME vs 314.1 MME; P < 0.0001). The methadone cohort required 44% fewer MME than the usual care cohort on POD 0 (median MME, 15.8 vs 36; P = 0.025), with low and not significantly different opioid use in both cohorts on POD 1 (15.5 MME vs 7.5 MME; P = 0.47). Weight-based methadone dosing ranged from 0.1 to 0.4 mg/kg (mean, 0.22 mg/kg). There were no significant differences in pain scores, time to extubation, use of CPAP or BiPAP, or ICU and hospital LOS. Conclusion Intraoperative IV methadone in cardiac surgery patients was safe and significantly reduced intraoperative and postoperative opioid requirements on POD 0.

Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine

2019 ◽  
Vol 14 (6) ◽  
pp. 512-518
Author(s):  
Mario Castillo-Sang ◽  
Cheryl Bartone ◽  
Cassady Palmer ◽  
Vien T. Truong ◽  
Brian Kelly ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Mitral Valve ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Length ◽  
Minimally Invasive Cardiac Surgery ◽  
Hospital Length Of Stay ◽  
Liposomal Bupivacaine ◽  
Asd Closure

Objective Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations. Methods Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( n = 12). An early cohort was treated with standard postoperative analgesia while another underwent intraoperative field block with LB immediately after incision. We compared postoperative pain level, narcotic utilization (morphine milligram equivalent), and intensive care unit (ICU) and hospital length of stay. Results The procedures included 48 isolated mitral valve replacements (MVR); 2 MVR with other procedures; 93 mitral valve repairs (MVRr); 9 MVRr with other procedures; 4 isolated tricuspid valve repairs; 2 myxoma resections; 1 ASD closure. There were 13 patients in the non-LB group and 146 patients in the LB group. Use of LB decreased mean postoperative narcotic utilization by 50% ( P = 0.003). The LB group had lower pain levels on postoperative day 1 ( P = 0.039), which continued through postoperative day 5 ( P = 0.030). We found no difference in ICU or hospital length of stay between groups. There were no complications from LB field block. Conclusions LB field block decreases postoperative pain and narcotic utilization after cardiac surgery via a RMT, but it does not reduce length of stay. The technique is safe and should be considered in all patients undergoing RMT cardiac surgery.

scholarly journals Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis

2018 ◽  
Vol 26 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Mathew P Doyle ◽  
Praveen Indraratna ◽  
Daniel T Tardo ◽  
Sheen CS Peeceeyen ◽  
Gregory E Peoples
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Aerobic Exercise ◽  
Usual Care ◽  
Hospital Discharge ◽  
Postoperative Period ◽  
Meta Analysis ◽  
Early Postoperative Period ◽  
Mean Difference ◽  
Safety And Efficacy

Background Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2–6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period. Methods A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery. A meta-analysis was performed comparing functional, aerobic and safety outcomes in patients receiving early postoperative aerobic exercise compared with usual postoperative care. Results Six-minute walk test distance at hospital discharge was 419 ± 88 m in early aerobic exercise patients versus 341 ± 81 m in those receiving usual care (mean difference 69.5 m, 95% confidence interval (CI) 39.2–99.7 m, p < 0.00001). Peak aerobic power was 18.6 ± 3.8 ml·kg–1·min–1 in those receiving early exercise versus 15.0 ± 2.1 ml·kg–1·min–1 in usual care (mean difference 3.20 ml·kg–1·min–1, 95% CI 1.45–4.95, p = 0.0003). There was no significant difference in adverse events rates between the two groups (odds ratio 0.41, 95% CI 0.12–1.42, p = 0.16). Conclusion Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery. While adverse event rates did not differ significantly, patients included were very low risk. Further studies are required to adequately assess safety outcomes of aerobic exercise commenced early after cardiac surgery.

A Multicenter, Open-Label, Randomized Controlled Trial of a Conservative Fluid Management Strategy Compared With Usual Care in Participants After Cardiac Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Rachael L. Parke ◽  
Eileen Gilder ◽  
Michael J. Gillham ◽  
Laurence J. C. Walker ◽  
Michael J. Bailey ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Usual Care ◽  
Management Strategy ◽  
Controlled Trial ◽  
Fluid Management ◽  
Open Label ◽  
Randomized Controlled

scholarly journals A Novel Use of Liposomal Bupivacaine in Erector Spinae Plane Block for Pediatric Congenital Cardiac Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Stylianos Voulgarelis ◽  
Gregory M. Halenda ◽  
Justinn M. Tanem
Keyword(s):  
Cardiac Surgery ◽  
Vascular Ring ◽  
Pediatric Cardiac Surgery ◽  
Erector Spinae ◽  
Control Technique ◽  
Liposomal Bupivacaine ◽  
Erector Spinae Plane Block ◽  
Tube Removal ◽  
Attractive Option ◽  
Perioperative Course

We describe the use of liposomal bupivacaine (Exparel) in erector spinae plane blocks for two patients undergoing pediatric cardiac surgery with cardiopulmonary bypass and one undergoing division of the compressive vascular ring. The perioperative course of all patients was remarkable for low pain and sedation scores, especially after chest tube removal. Erector spinae plane blocks are an expanding pain-control technique in both adult and pediatric cardiac surgery for postoperative analgesia. Liposomal bupivacaine offers prolonged analgesia and may be an attractive option for this indication.

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