Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart.

Mukhit Dossov 1 * , Serik Seitenov 1, Baurzhan Babashev 1, Azhar Zhailauova 1, Arman Kazmagambetov 1, Ruslan Kulchukov 1, Rustam Salakhanov 1, Akerke Bekseitova 1
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1 Anesthesiology & ICU Department Medical Centre Hospital of President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 1, pp. 35-40.
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Author Contributions
Conceptualization M. D and A. K.; methodology, M. D., S. S. and B. B.; validation, M. D., A. Z. and S. S.; formal analysis, S. S. and A. K.; investigation, R. K., A. K., R. S. and A. B.; resources, M. D., A. K. and R. K.; data curation, M. D., S. S., A. Z. and A. K.; writing – original draft preparation, M. D., A. Z. and S. S.; writing – review and editing, S. S., M. D. and A. Z.; visualization, B. B., A. K., A. B. and M. D.; supervision, S. S.; project administration, S. S. and M. D.; funding acquisition, S. S. All authors have read and agreed to the published version of the manuscript.


Purpose: To determine the effectiveness of intrapleural analgesia (IPA) for pain relief after minimally invasive coronary artery bypass surgery on a beating heart.
Methods: We prospectively studied 35 patients who underwent coronary artery bypass grafting on a beating heart through a mini thoracotomy access on the left. Patients were divided into two groups: group I received IPA with a catheter (n=16) and group II patients were not introduced intrapleural analgesia (n=19). Postoperative pain was assessed according to the visual analogue scale (VAS), consumption of analgesics, extubation time, arterial blood gas parameters. Adequacy of respiration and lung ventilation were estimated by electrical impedance tomography.
Results: Extubation time after surgery did not differ in both groups. Arterial oxygen partial pressure was higher (p<0.05) in the first group (160.82±46.98) compared to the second group (111.42±49.26). Regarding the EIT in the quadrant mode, distribution of tidal volume was better in the first group (p<0.05) in the 2nd, 3rd quadrant and in the layer mode, the second layer of the first group showed better results compared to the same layer of the second group. After extubation, average pain score according to VAS was four points for the first group and six points for the second group. On the 1st and 2nd day pain scores were the same in both groups. Postoperative analgesia by promedol was required only for 1 patient (6.25%) from the first group, and 14 patients from the second group (73.7%). Additionally, tramadol was administered to 43.5% (7 patients) of the first group and 26.3% (5 patients) of the second group.
Conclusion: IPA can be used as one of the effective treatments for postoperative pain in minimally invasive coronary artery bypass surgeries. IPA promotes less use of opioids. An improvement in respiration was observed with reduction in postoperative pain.


Dossov M, Seitenov S, Babashev B, Zhailauova A, Kazmagambetov A, Kulchukov R, et al. Analysis of the effectiveness of intrapleural analgesia after minimally invasive coronary artery bypass grafting on a beating heart.. J CLIN MED KAZ. 2024;21(1):35-40.


  • Ali JM, PhD. Abu-Omar Ya, Minimally invasive cardiac surgery – a Fad or the Future? J Thorac Dis. 2021 Mar; 13(3): 1882–1885.
  • Marin-Cuartas M, et al. Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques. JTCVS Techniques, 2021; 10: 170–177.
  • White A, Patvardhan Ch, Falter F. Anesthesia for minimally invasive cardiac surgery. J Thorac Dis. 2021; 13(3): 1886–1898.
  • Sherazee EA, Chen SA, Li D, Frank P, Kiaii B. Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery. Innovations (Phila). 2022; 17(3): 167-176.
  • Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019; 55: 91–115.
  • Wick EC, Grant MC, and Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg. 2017; 152: 691–697.
  • Piccioni F, Segat M, Falini S, et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols. J Thorac Dis. 2018; 10: 555–563.
  • Zaouter C, Oses P, Assatourian S, et al. Reduced length of hospital stay for cardiac surgery-implementing an optimized perioperative pathway: prospective evaluation of an Enhanced Recovery After Surgery program designed for mini-invasive aortic valve replacement. J Cardiothorac Vasc Anesth. 2019; 33: 3010–3019.
  • Bachmann-Mennenga B, et al. Intercostal nerve block, interpleural analgesia, thoracic epidural block or systemic opioid application for pain relief after thoracotomy? European Journal of Cardio-Thoracic Surgery. 1993; 7(1): 12–18.
  • Chou R, et al. (2016) ‘Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council’, The Journal of Pain. 2016; 17(2): 131–157.
  • Demmy TL, et al. Chest tube–delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. The Annals of Thoracic Surgery. 2009; 87(4): 1040–1047.
  • Joshi GP, et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesthesia &amp; Analgesia. 2008; 107(3): 1026–1040.
  • Wedad M, Zaki MK, Haleem M. The effect of addition of wound infiltration with local anesthetics to interpleural block on post-thoracotomy pain, pulmonary function and stress response in comparison to thoracic epidural and paravertebral block. Egypt J Anaesth 2004; 20: 67–72.
  • Brockmeier V, et al. Interpleural or thoracic epidural analgesia for pain after thoracotomy. A double-blind study. Acta Anaesthesiologica Scandinavica. 1994; 38(4): 317–321.
  • Karmakar MK and Ho AM-H. Acute pain management of patients with multiple fractured ribs. The Journal of Trauma: Injury, Infection, and Critical Care. 2003; 54(3): 615–625.
  • Shinohara K, et al. Interpleural block for patients with multiple rib fractures: Comparison with epidural block. The Journal of Emergency Medicine. 1994; 12(4): 441–446.
  • Luchette FA, et al. Prospective evaluation of epidural versus intrapleural catheters for analgesia in chest wall trauma. The Journal of Trauma: Injury, Infection, and Critical Care. 1994; 36(6): 865–870.
  • Short K, Scheeres D, Mlakar J, Dean R. Evaluation of intrapleural analgesia in the management of blunt traumatic chest wall pain: a clinical trial. Am Surg. 1996; 62: 488–493.
  • Yu S, et al. Regional analgesia for minimally invasive cardiac surgery. Journal of Cardiac Surgery. 2019; 34(11), pp. 1289–1296.
  • Ishikawa Y, et al. Intrapleural analgesia using Ropivacaine for postoperative pain relief after minimally invasive thoracoscopic surgery. Annals of Thoracic and Cardiovascular Surgery. 2012; 18(5): 429–433.
  • Dravid RM, Paul RE. Interpleural block – part 1. Anesthesia. 2007; 62 (10): 1039-1049.
  • Mehta Ya. A comparative evaluation of intrapleural and thoracic epidural analgesia for postoperative pain relief after minimally invasive direct coronary artery bypass surgery. Journal of Cardiothoracic and Vascular Anesthesia. 1998; 12(2): 162-165.
  • Cogan J, André M. Injection of Bupivacaine into the Pleural and Mediastinal Drains: A Novel Approach for Decreasing Incident Pain After Cardiac Surgery – Montreal Heart Institute Experience. Journal of Pain Research. 2020; 13: 3409–3413.
  • Carlos E, et al. Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery A Systematic Review and Meta-analysis. JAMA Network Open. 2021; 4(11): e2133394.
  • Landry E, et al. A Successful Opioid-Free Anesthetic in a Patient Undergoing Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33(9): 2517-2520.
  • Ogus H, et al. Effects of Intrapleural Analgesia on Pulmonary Function and Postoperative Pain in Patients With Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Graft Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2007; 21 (6): 816-819.