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Femoral nerve block with propofol sedation versus general anesthesia in patients with severe cardiac dysfunction undergoing autologous myoblast sheet transplantation

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Abstract

Purpose

Regional anesthesia is more favorable than general anesthesia in patients with severe comorbidity; however, data on the superiority of peripheral nerve blocks over general anesthesia in patients with severe cardiac dysfunction are lacking. We aimed to demonstrate that peripheral nerve blocks reduce perioperative analgesic requirements and promote faster recovery compared to general anesthesia.

Methods

We retrospectively evaluated intraoperative blood pressure, perioperative medications, and postoperative recovery in patients who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation. We compared patients who received general anesthesia (group G, n = 27) to those who received femoral nerve block with propofol sedation (group B, n = 22).

Results

Left ventricular ejection fraction was 24% on average, with no significant difference between groups. Compared with group G, a lower dose of propofol was used intraoperatively (1.25 versus 2.0 µg/mL, respectively; P < 0.001) and fewer patients required opioids (13.6 versus 100%, P < 0.01) in group B. Additionally, the lowest intraoperative mean blood pressure was higher (54 versus 48 mmHg, respectively; P = 0.02) in group B. More patients received postoperative analgesic drugs (51.9 versus 13.6%, P = 0.01) and they received them more frequently (1 [0–3] versus 0 [0–1], P = 0.02) in group G. The length of heart care unit stay was shorter in group B than group G (0 [0–18.5] versus 17 [0–47] h, respectively; P < 0.0001).

Conclusions

Femoral nerve block with sedation was more beneficial than general anesthesia in patients with severe cardiac dysfunction who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation.

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Acknowledgements

We thank Dr. Shigeru Miyagawa and Dr. Keitaro Domae for valuable suggestions regarding this study.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan

    Kenta Okitsu, Takeshi Iritakenishi, Akira Iura, Michioki Kuri & Yuji Fujino

Authors
  1. Kenta Okitsu
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  2. Takeshi Iritakenishi
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  3. Akira Iura
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  4. Michioki Kuri
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  5. Yuji Fujino
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Corresponding author

Correspondence to Kenta Okitsu.

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The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Okitsu, K., Iritakenishi, T., Iura, A. et al. Femoral nerve block with propofol sedation versus general anesthesia in patients with severe cardiac dysfunction undergoing autologous myoblast sheet transplantation. J Anesth 31, 672–677 (2017). https://doi.org/10.1007/s00540-017-2376-5

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  • DOI: https://doi.org/10.1007/s00540-017-2376-5

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