Imaging evaluation of continuous extrapleural intercostal nerve block for minimally invasive cardiac surgery: a case report

• Main Authors: Misa Terauchi, Hiroai Okutani, Daisuke Ishimoto, Noriko Shimode, Yumiko Takao, Munetaka Hirose
• Format: Article
• Language: English
• Published: SpringerOpen 2021-06-01
• Series: JA Clinical Reports
• Subjects: Continuous extrapleural intercostal nerve block; Minimally invasive cardiac surgery; Postoperative pain; Contrast medium; Intercostal thoracotomy
• Online Access: https://doi.org/10.1186/s40981-021-00450-y

Abstract Background Spinal nerve block is difficult with minimally invasive cardiac surgery (MICS), because of the risk of serious bleeding complications due to full heparinization. Continuous extrapleural intercostal nerve block (CEINB) is a postoperative pain treatment for intercostal thoracotomy, with fewer complications. Here, we report a case in which imaging evaluation of CEINB with contrast medium was conducted to anatomically confirm the spread of local anesthetics after MICS. Case presentation A 65-year-old woman with severe mitral regurgitation underwent mitral valve plasty under general anesthesia via right-sided mini-thoracotomy. A CEINB catheter was placed before the incision was closed, without creating a conventional extrapleural pocket. We conducted an imaging evaluation with a contrast medium via the inserted catheter and confirmed sufficient spread around the intercostal nerve area. In addition, postoperative pain was well controlled by the nerve block. Conclusions Imaging evaluation of CEINB with contrast medium could increase analgesic quality and decrease complications post-MICS.