Abstract
OBJECTIVE: This study aimed to evaluate the postoperative pain in patients with hypertrophic cardiomyopathy who underwent transapical beating-heart septal myectomy (TA-BSM) and to explore whether a thoracic paravertebral nerve block (TPVB) can effectively alleviate the postoperative pain resulting from this surgical procedure. METHODS: Patients aged 18-75 years, classified as American Society of Anesthesiologists II-III, who underwent TA-BSM between April and September 2023, were included. A total of 197 patients were initially enrolled and evaluated in this study. Following the application of the inclusion and exclusion criteria, 136 participants were allocated to two cohorts: a control group (CON group) and a TPVB group, based on whether a TPVB was administered before the surgical intervention. Demographic data, perioperative characteristics, visual analog scale scores, analgesic strategy, and Quality of recovery-15 scores were evaluated. RESULTS: After inverse probability of treatment weighting (IPTW) adjustment, the standardized mean difference in baseline characteristics between the two groups was <0.1. The incidence of moderate-to-severe pain on postoperative day 7 was 51.7% in the TPVB group compared to 71.1% in the CON group. The adjusted relative risk for moderate-to-severe pain was 0.748 [95% CI, 0.565 to 0.990] via IPTW analysis. The oral morphine equivalent administered via PCA during the initial 48 hours post-surgery was significantly lower in the TPVB group than in the CON group (225 vs 195; median difference, 34.5 [95% CI, 21 to 48]; P <0.001). CONCLUSION: Preoperative administration of a single TPVB before TA-BSM was associated with a reduced postoperative pain intensity, ranging from moderate to severe, and a subsequent decrease in opioid usage. TPVB may be a beneficial analgesic strategy for patients undergoing TA-BSM.