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202: Anatomic study of the endothoracic fascia in paravertebral location
178
Posters
•
Miscellaneous
106. A retrospective survey of the prevalence of chronic post-surgical pain after cardiac surgery G.L. Becher1, N.B. Scott1, J. Bruce2 of Perioperative Medicine, Golden Jubilee National Hospital, Glasgow, UK, 2Department of Public Health, University of Aberdeen, Aberdeen, UK
1Department
Background: Chronic post-surgical pain (CPSP) after coronary artery bypass grafting (CABG) is a recognised complication with an incidence of 28-56%. Benefits of thoracic epidural anaesthesia (TEA) for CABG are well-documented but no study has determined its impact on the prevalence of CPSP. Methods: We conducted a postal questionnaire survey of 80 patients who had undergone CABG since 2001. The questionnaire consisted of components of the Short Form 36, McGill pain questionnaire and Rose angina questionnaire. CPSP was defined as pain in the location of surgery, different from pre-operative pain, persisting beyond 3 months. Data from patients who received a TEA was analysed. Results: Of the 43 responders, 35(43.75%) gave consent to the study. The number of patients who received a TEA was 30(85.7%). The median age in this group was 67.5 years (range 38-82 years). 23.3% (n⫽7) were female and 76.6%(n⫽23) were male. The prevalence of CPSP in the TEA group was 30%(n⫽9). In this group, 1 reported chest pain only(11.1%), 2(22.2%) reported leg pain only and 6(33.3%) had both chest and leg pain. 77.7%(n⫽7) of the CPSP group reported sleep disturbance because of pain, and 66%(n⫽6) reported interference with daily activities. Conclusions: CPSP prevalence in this survey is consistent with previous studies of CPSP after CABG. The data supports the need for a larger comparative study between cardiac surgery databases to assess the impact of TEA on CPSP.
TEA Patient Characteristics
No. of patients Male/Female Median age (years)
No CPSP
CPSP
21 16/5 70 (49–81)
9 7/2 62 (38–82)
202. Anatomic study of the endothoracic fascia in paravertebral location H. Ludot1, J.M. Labrousse2, F.O. Ponson1, C. Avisse3, J.M. Malinovsky4 1Department of Anesthesia, American Memorial Hospital, CHU, Reims, France, 2Department of ENT Surgery, CHU, Reims, France, 3Department of Anatomy, CHU, Reims, France, 4Department of Anesthesia and Intensive Care, CHU, Reims, France Background: The usual anatomic description of the paravertebral situation of the endothoracic fascia (FED) as medially fuse with the periostum at the midpoint of the vertebral body was disregarded with the embryogenesis and remains inconclusive. We want to state specifically the internal limits of the thoracic paravertebral space (TPVS). Materials and Methods: In 12 adult subjects preserving with Winkler solution, a TPVS infiltration with colored latex was performed by the Eason and Wyatt modified by Lo¨nnqvist technique. Then, these spaces were dissected by anterior approach. Results: The TPVS is a wedge-shaped space that lies on either side of the vertebral body. A fibro-elastic structure, the FED is found in the inner side of the innermost intercostal muscles, interposed between the parietal pleura and the superior costo-transverse ligament. During dissection it is found firmly attached to the parietal pleura. In medially, it fuses with the other epimysiums of the posterior mediastinum and not with the periostum of the vertebral body. Thus, the investing fascia covers the sympathetic trunk and the Azygos venous. It divides the TPVS into two compartments, the extrapleural paravertebral, anterior, and posterior subendothoracic paravertebral compartment. In the 12 dissections, the sympathetic trunk is located near the Azygos in this posterior space, sometimes surrounded with latex, in the fatty tissue, within which lies the intercostal nerves and vessels, the rami communicantes and the dorsal ramus. Discussion: According to clinical experience, the anatomical dissections explain that the sympathetic trunk is not exceptionally susceptible to local anesthetic paravertebral block.
Posters
•
Miscellaneous
106. A retrospective survey of the prevalence of chronic post-surgical pain after cardiac surgery G.L. Becher1, N.B. Scott1, J. Bruce2 of Perioperative Medicine, Golden Jubilee National Hospital, Glasgow, UK, 2Department of Public Health, University of Aberdeen, Aberdeen, UK
1Department
Background: Chronic post-surgical pain (CPSP) after coronary artery bypass grafting (CABG) is a recognised complication with an incidence of 28-56%. Benefits of thoracic epidural anaesthesia (TEA) for CABG are well-documented but no study has determined its impact on the prevalence of CPSP. Methods: We conducted a postal questionnaire survey of 80 patients who had undergone CABG since 2001. The questionnaire consisted of components of the Short Form 36, McGill pain questionnaire and Rose angina questionnaire. CPSP was defined as pain in the location of surgery, different from pre-operative pain, persisting beyond 3 months. Data from patients who received a TEA was analysed. Results: Of the 43 responders, 35(43.75%) gave consent to the study. The number of patients who received a TEA was 30(85.7%). The median age in this group was 67.5 years (range 38-82 years). 23.3% (n⫽7) were female and 76.6%(n⫽23) were male. The prevalence of CPSP in the TEA group was 30%(n⫽9). In this group, 1 reported chest pain only(11.1%), 2(22.2%) reported leg pain only and 6(33.3%) had both chest and leg pain. 77.7%(n⫽7) of the CPSP group reported sleep disturbance because of pain, and 66%(n⫽6) reported interference with daily activities. Conclusions: CPSP prevalence in this survey is consistent with previous studies of CPSP after CABG. The data supports the need for a larger comparative study between cardiac surgery databases to assess the impact of TEA on CPSP.
TEA Patient Characteristics
No. of patients Male/Female Median age (years)
No CPSP
CPSP
21 16/5 70 (49–81)
9 7/2 62 (38–82)
202. Anatomic study of the endothoracic fascia in paravertebral location H. Ludot1, J.M. Labrousse2, F.O. Ponson1, C. Avisse3, J.M. Malinovsky4 1Department of Anesthesia, American Memorial Hospital, CHU, Reims, France, 2Department of ENT Surgery, CHU, Reims, France, 3Department of Anatomy, CHU, Reims, France, 4Department of Anesthesia and Intensive Care, CHU, Reims, France Background: The usual anatomic description of the paravertebral situation of the endothoracic fascia (FED) as medially fuse with the periostum at the midpoint of the vertebral body was disregarded with the embryogenesis and remains inconclusive. We want to state specifically the internal limits of the thoracic paravertebral space (TPVS). Materials and Methods: In 12 adult subjects preserving with Winkler solution, a TPVS infiltration with colored latex was performed by the Eason and Wyatt modified by Lo¨nnqvist technique. Then, these spaces were dissected by anterior approach. Results: The TPVS is a wedge-shaped space that lies on either side of the vertebral body. A fibro-elastic structure, the FED is found in the inner side of the innermost intercostal muscles, interposed between the parietal pleura and the superior costo-transverse ligament. During dissection it is found firmly attached to the parietal pleura. In medially, it fuses with the other epimysiums of the posterior mediastinum and not with the periostum of the vertebral body. Thus, the investing fascia covers the sympathetic trunk and the Azygos venous. It divides the TPVS into two compartments, the extrapleural paravertebral, anterior, and posterior subendothoracic paravertebral compartment. In the 12 dissections, the sympathetic trunk is located near the Azygos in this posterior space, sometimes surrounded with latex, in the fatty tissue, within which lies the intercostal nerves and vessels, the rami communicantes and the dorsal ramus. Discussion: According to clinical experience, the anatomical dissections explain that the sympathetic trunk is not exceptionally susceptible to local anesthetic paravertebral block.