Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart

Mukhit Dossov, Serik Seitenov, Baurzhan Babashev, Azhar Zhailauova, A. Kazmagambetov, R. Kulchukov, R. Salakhanov, A. Bekseitova

Journal of Clinical Medicine of Kazakhstan, 2024

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DOI 10.23950/jcmk/14267
Data confidence 85 high
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Abstract

Purpose: To determine the effectiveness of intrapleural analgesia (IPA) for pain relief after minimally invasive coronary artery bypass surgery on a beating heart. Methods: We prospectively studied 35 patients who underwent coronary artery bypass grafting on a beating heart through a mini thoracotomy access on the left. Patients were divided into two groups: group I received IPA with a catheter (n=16) and group II patients were not introduced intrapleural analgesia (n=19). Postoperative pain was assessed according to the visual analogue scale (VAS), consumption of analgesics, extubation time, arterial blood gas parameters. Adequacy of respiration and lung ventilation were estimated by electrical impedance tomography. Results: Extubation time after surgery did not differ in both groups. Arterial oxygen partial pressure was higher (p<0.05) in the first group (160.82±46.98) compared to the second group (111.42±49.26). Regarding the EIT in the quadrant mode, distribution of tidal volume was better in the first group (p<0.05) in the 2nd, 3rd quadrant and in the layer mode, the second layer of the first group showed better results compared to the same layer of the second group. After extubation, average pain score according to VAS was four points for the first group and six points for the second group. On the 1st and 2nd day pain scores were the same in both groups. Postoperative analgesia by promedol was required only for 1 patient (6.25%) from the first group, and 14 patients from the second group (73.7%). Additionally, tramadol was administered to 43.5% (7 patients) of the first group and 26.3% (5 patients) of the second group. Conclusion: IPA can be used as one of the effective treatments for postoperative pain in minimally invasive coronary artery bypass surgeries. IPA promotes less use of opioids. An improvement in respiration was observed with reduction in postoperative pain.