TY - JOUR
T1 - Regional Analgesia for Cardiac Surgery. Part 2
T2 - Peripheral Regional Analgesia for Cardiac Surgery
AU - Devarajan, Jagan
AU - Balasubramanian, Sennaraj
AU - Shariat, Ali N.
AU - Bhatt, Himani V.
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2021/12
Y1 - 2021/12
N2 - The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in “Enhanced Recovery after Cardiac Surgery (ERACS)” protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.
AB - The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in “Enhanced Recovery after Cardiac Surgery (ERACS)” protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.
KW - ERACS
KW - cardiac surgery
KW - erector spinae block
KW - fascial plane block
KW - opioid sparing
KW - regional block
UR - http://www.scopus.com/inward/record.url?scp=85104265444&partnerID=8YFLogxK
U2 - 10.1177/10892532211002382
DO - 10.1177/10892532211002382
M3 - Review article
C2 - 33827348
AN - SCOPUS:85104265444
SN - 1089-2532
VL - 25
SP - 265
EP - 279
JO - Seminars in Cardiothoracic and Vascular Anesthesia
JF - Seminars in Cardiothoracic and Vascular Anesthesia
IS - 4
ER -