BACKGROUND: Less-invasive techniques for left ventricular assist device (LVAD) implantation have shown promising outcomes but are associated with significant postoperative pain. We aim to investigate the use of ultrasound-guided regional nerve blocks to improve pain management during these procedures. METHODS: We retrospectively reviewed patients implanted with a HeartMate 3 LVAD via complete sternal-sparing (CSS) approach at our institution from February 2018 to July 2018. Patients were grouped based on their postoperative pain management plan-those who received a regional nerve block plus multimodal analgesia and a control group who received standard multimodal analgesia alone. Pain scores and analgesic use were recorded for all patients during the initial 72 hours postoperatively. RESULTS: Preoperative characteristics were similar between cohorts. Of the 28 patients included in the study, 15 (54%) received a postoperative regional nerve block. Patients who received a nerve block had significantly lower pain scores and required a lower dose of opioid analgesics (70.7 ± 13.9 vs 124.6 ± 19.3 morphine equivalents, P = 0.029) during the first 72 hours postoperatively. There was no difference in time to extubation, intensive care unit length of stay, or hospital length of stay. CONCLUSIONS: Optimizing postoperative analgesia using a regional nerve block is associated with decreased opioid use and decreased postoperative pain after CSS LVAD implantation. Regional nerve blocks should be included as part of a protocol-based postoperative pain management program.
BACKGROUND: Less-invasive techniques for left ventricular assist device (LVAD) implantation have shown promising outcomes but are associated with significant postoperative pain. We aim to investigate the use of ultrasound-guided regional nerve blocks to improve pain management during these procedures. METHODS: We retrospectively reviewed patients implanted with a HeartMate 3 LVAD via complete sternal-sparing (CSS) approach at our institution from February 2018 to July 2018. Patients were grouped based on their postoperative pain management plan-those who received a regional nerve block plus multimodal analgesia and a control group who received standard multimodal analgesia alone. Pain scores and analgesic use were recorded for all patients during the initial 72 hours postoperatively. RESULTS: Preoperative characteristics were similar between cohorts. Of the 28 patients included in the study, 15 (54%) received a postoperative regional nerve block. Patients who received a nerve block had significantly lower pain scores and required a lower dose of opioid analgesics (70.7 ± 13.9 vs 124.6 ± 19.3 morphine equivalents, P = 0.029) during the first 72 hours postoperatively. There was no difference in time to extubation, intensive care unit length of stay, or hospital length of stay. CONCLUSIONS: Optimizing postoperative analgesia using a regional nerve block is associated with decreased opioid use and decreased postoperative pain after CSSLVAD implantation. Regional nerve blocks should be included as part of a protocol-based postoperative pain management program.