Regional anesthesia considerations for cardiac surgery

Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):387-406. doi: 10.1016/j.bpa.2019.07.008. Epub 2019 Jul 17.

Abstract

Pain is a significant consequence of cardiac surgery and newer techniques in cardiac anesthesia have provided an impetus for the development of multimodal techniques to manage acute pain in this setting. In this regard, regional anesthesia techniques have been increasingly used in many cardiac surgical procedures, for the purposes of reducing perioperative consumption of opioid agents and enhanced recovery after surgery. The present investigation focuses on most currently used regional techniques in cardiac surgical procedures. These regional techniques include chest wall blocks (e.g., PECS I and II, SAP, ESB, PVB), sternal blocks (e.g., TTMPB, PSINB), and neuraxial blocks (e.g., TEA, high spinal anesthesia). The present investigation also summarizes indications, technique, complications, and potential clinical benefits of these evolving regional techniques. Cardiac surgery patients may benefit from application of these regional techniques with well controlled indications and careful patient selections.

Keywords: anesthesia; chest wall; nerve blocks; regional anesthesia; thoracic nerves.

Publication types

  • Review

MeSH terms

  • Anesthesia, Conduction / methods*
  • Anesthetics, Local / administration & dosage
  • Cardiac Surgical Procedures / methods*
  • Humans
  • Intercostal Nerves / drug effects
  • Intercostal Nerves / physiology
  • Pain Measurement / methods*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Thoracic Nerves / drug effects
  • Thoracic Nerves / physiology

Substances

  • Anesthetics, Local