Daniel Zapata, MD
(He/Him/His)
Rank
Fellow or Postdoc
Department
"Anesthesiology, Perioperative and Pain Medicine",Medicine
Authors
Daniel A. Zapata, Andres Zorrilla-Vaca, Sergey Karamnov, Gavin Ovzak, Antonio Coppolino, John Finnigan, Kamen Vlassakov, Matthew Allen, Alexander Stone
Principal Investigator
Alexander Stone
Twitter / Website
Twitter: @danielzapa43942
Categories
Introduction: Truncal nerve blocks are effective in thoracic surgery to improve postoperative analgesia and reduce opioid consumption. In lung transplantation, continuous parasternal nerve blockade is an alternative technique for pain control, which may improve pulmonary outcomes. This study aimed to determine the impact of continuous parasternal nerve blocks on reintubation rates following lung transplantation.
Methods: This is an exploratory analysis of a single-center cohort of patients undergoing allograft lung transplantation from January 2020 to June 2024. Two groups of patients were identified based on the presence of parasternal nerve catheters (PNC) within the first week after lung transplantation. Our primary outcome was reintubation within 30 days after first extubation attempt. Other secondary outcomes included pneumonia, primary graft dysfunction, opioid consumption and pain scores at the intensive care unit (ICU). Both groups were matched in 1:1 fashion with a caliper of 0.03 based on confounders (age, type of mechanical circulatory support during transplantation, bilateral or single lung, ex-vivo perfusion, ischemia time, surgery time, cardiac bypass time, history of smoking, pulmonary hypertension, preoperative creatinine, blood transfusions, diabetes, chronic kidney disease, coronary artery disease).
Results: Out of 188 lung transplant recipients, 49 patients received parasternal nerve block catheters. After matching, 30 patients were allocated to each group with similar clinical and demographic characteristics (Table 1, Figure 1). The incidence of reintubation was significantly lower in the PNC group (16.7% vs 40.0%, P=0.04). In time-to-event analysis, the Kaplan-Meier curves of reintubation rates between both groups suggested a possible clinical difference (HR 0.34, 95%CI 0.11-1.06, P=0.06; Figure 2). Both groups had similar ICU length of stay (6 days [4-14] in PNC group vs 7 days [4-26] in control group; P=0.31) and hospital stay (21 days [16-39] in PNC group vs 31 days [16-53] in control group; P=0.82).
Conclusions: Parasternal nerve block is an effective analgesic alternative that seems to decrease the risk of reintubation after lung transplantation. Further studies with larger sample size are needed to confirm the respiratory benefits of parasternal block catheters in lung transplantation.