Regional anesthesia considerations for cardiac surgery

Liu, Henry; Emelife, Patrick I.; Prabhakar, Amit; Moll, Vanessa; Kendrick, Julia B.; Parr, Allan T.; Hyatali, Farees; Thakur, Pankaj; Li, Jinlei; Cornett, Elyse M.; Urman, Richard D.; Fox, Charles J.; Kaye, Alan D.

doi:10.1016/j.bpa.2019.07.008

Cited by 26 publications

(14 citation statements)

References 58 publications

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“…The serratus anterior plane block (SAPB) is an ultrasound-guided technique for the axillary region, and is more lateral and posterior than PEC blocks. Local anesthetic is injected in the plane between the serratus anterior and latissimus dorsi muscles, where the intercostobrachial nerve, lateral cutaneous branches of the intercostal nerves (T3–T9), long thoracic nerve, and thoracodorsal nerve are located [ 6 , 15 ]. It covers a larger posterolateral area than the PECS block.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Regional analgesia techniques for effective recovery from coronary artery bypass surgeries: a retrospective study involving the experience of a single center

Coşarcan

Sezer

Gürkahraman

et al. 2022

J Cardiothorac Surg

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Background Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences. Methods This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined. Results The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block. Conclusion Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures. Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.

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Section: Discussionmentioning

confidence: 99%

“…With minimally invasive cardiac surgery, fast track anesthesia techniques and multimodal analgesia, including regional anesthesia techniques, have focused on blocking peripheral nerves in neural planes under ultrasonic guidance. Chest wall blocks are more recent and easier alternatives to neuraxial analgesia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Regional analgesia techniques for effective recovery from coronary artery bypass surgeries: a retrospective study involving the experience of a single center

Coşarcan

Sezer

Gürkahraman

et al. 2022

J Cardiothorac Surg

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“… 62 , 80 , 81 Similarly, regional anesthesia has been increasingly implemented as part of a multimodal strategy in cardiac surgery and related ERAS protocols to reduce opioid consumption. 82 , 83 The addition of emerging truncal fascial plane blocks for pain optimization presents a promising new area within cardiac ERAS. 55 , 84 Because cardiac ERAS pathways often highlight opioid-sparing strategies and acute pain management optimization, 6 , 85 , 86 implementation of these protocols aligns with addressing the aforementioned factors thought to contribute to PPP.…”

Section: Prevention Of Pppmentioning

confidence: 99%

Persistent Pain After Cardiac Surgery: Prevention and Management

Hallman

Smeltz

2021

Semin Cardiothorac Vasc Anesth

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Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.

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“…Despite that, there is abundant evidence comparing right mini thoracotomy to standard sternotomy (15). Many studies reported less post-operative pain in MICS as opposed to sternotomy (54)(55)(56)(57). This is thought to be resulting from keeping the integrity of the sternum which leads to better bony thorax stability.…”

Section: Postoperative Painmentioning

confidence: 99%

Minimally invasive tricuspid valve surgery

Abdelbar¹,

Kenawy²,

Zacharias³

2021

J Thorac Dis

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Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.

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Regional anesthesia considerations for cardiac surgery

Cited by 26 publications

References 58 publications

Regional analgesia techniques for effective recovery from coronary artery bypass surgeries: a retrospective study involving the experience of a single center

Regional analgesia techniques for effective recovery from coronary artery bypass surgeries: a retrospective study involving the experience of a single center

Persistent Pain After Cardiac Surgery: Prevention and Management

Minimally invasive tricuspid valve surgery

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