Peri-operative protocol
ESPB, neuromuscular block, pain, cough, infection, NRS
BLOOD, INFECTION
All the patients underwent the same anesthesia protocol. Induction to general anesthesia was conducted with 1.5–2 mg/kg propofol 1% and 0.75–1 mcg/kg remifentanil in a slow bolus followed by 0.6 mg/kg rocuronium. Total intravenous anesthesia was maintained with an infusion of 5 mg/kg/h propofol 1% and 0.02–0.03 mcg/kg/min remifentanil. Blood pressure was maintained with fluid administration and appropriate vasoactive drugs when needed. Reversion of neuromuscular block was performed by a bolus of 2 mg/kg sugammadex at the end of the surgery.Patients were constantly monitored (ECG, pulse oximetry, invasive blood pressure) from admission to the pre-op area until at least 48 hours after surgery. Nurses at the intensive care unit documented the post-operative numerical rating scale for pain (NRS) every hour in the first 48 hours except when the patient was asleep. The patients expressed their current NRS on a scale from 0 to 10 with 0 meaning no pain and 10 meaning the worst pain imaginable. Nurses asked the patients about their NRS at rest and at cough in the last hour, which included spontaneous and active cough but not respiratory physiotherapy.Every patient received a PCA pump with the protocol: demanded bolus 3 mg piritramide 1 mg/ml per 15 min with a maximum of 2 boluses per hour with no continuous infusion. If the pain reported by a patient was still higher than 3/10, a nurse applied an additional bolus of 3 mg piritramide. When a patient demanded more than 4 boluses per hour, the attending doctor initiated an infusion of 2 mg/h piritramide until the pain settled below 3/10. All the patients received regular doses of diclofenac and metamizole in terms of multimodal analgesia.The postoperative care of the ESPB catheter followed the same protocol as for the thoracic-epidural catheter. The attending physician evaluated the catheter insertion site every day, looking for signs of infection.All the patients performed maximal inspiratory and expiratory pressure (MIP/MEP) tests three times: on the day of the surgery prior to the surgical procedure, 24 and 48 hours later.