Regional Anesthesia in Cardiac Surgery: A Review of the Literature

Jiang, Tianyu; Ting, Andrewston; Leclerc, Michael; Calkins, Kerry; Huang, Jeffrey

doi:10.7759/cureus.18808

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…But the intraoperative anticoagulation is a concern expressed by many anesthesiologists. [ 33 ] Several chest wall blocks have been described in the last two decades and have been successfully used in patients undergoing cardiac surgeries. These blocks are pectoral nerve blocks (PECS 1 and PECS 2), serratus anterior plane block, parasternal blocks like transversus thoracis muscle plane block, and the ESPB.…”

Section: Discussionmentioning

confidence: 99%

Erector Spinae Plane Block for Postoperative Analgesia in Cardiac Surgeries- A Systematic Review and Meta-Analysis

Nair

Saxena

Borkar

et al. 2023

Annals of Cardiac Anaesthesia

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Ultrasound-guided erector spinae plane block (ESPB) has been used in many studies for providing opioid-sparing analgesia after various cardiac surgeries. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of ESPB in cardiac surgeries. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar to identify the studies in which ESPB was compared with the control group/sham block in patients undergoing cardiac surgeries. The primary outcomes were postoperative opioid consumption and postoperative pain scores. The secondary outcomes were intraoperative opioid consumption, ventilation time, time to the first mobilization, length of ICU and hospital stay, and adverse events. Out of 607 studies identified, 16 studies (n = 1110 patients) fulfilled inclusion criteria and were used for qualitative and quantitative analysis. Although, 24-hr opioid consumption were comparable in both groups group (MD, −18.74; 95% CI, −46.85 to 9.36, P = 0.16), the 48-hr opioid consumption was significantly less in ESPB group than control ((MD, −11.01; 95% CI, −19.98 to −−2.04, P = 0.02). The pain scores at various time intervals and intraoperative opioid consumption were significantly less in ESPB group. Moreover, duration of ventilation, time to the first mobilization, and length of ICU and hospital were also less in ESPB group (P < 0.00001, P < 0.00001, P < 0.00001, and P < 0.0001, respectively). This systematic review and meta-analysis demonstrated that ESPB provides opioid-sparing perioperative analgesia, facilitates early extubation and mobilization, leads to early discharge from ICU and hospital, and has lesser pruritus when compared to control in patients undergoing cardiac surgeries.

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Section: Discussionmentioning

confidence: 99%

Erector Spinae Plane Block for Postoperative Analgesia in Cardiac Surgeries- A Systematic Review and Meta-Analysis

Nair

Saxena

Borkar

et al. 2023

Annals of Cardiac Anaesthesia

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“…Neuraxial anesthesia may also worsen hypotension in patients with normal or low blood pressure. Additionally, there is a concern for increased risks of bleeding and hematoma formation with neuraxial anesthesia in the setting of high-dose intraoperative heparin required during CPB [9]. In contrast to neuraxial anesthesia, general anesthesia provides a secure airway in a patient at high risk of aspiration (being a full-term pregnant patient undergoing emergency surgery) who can quickly become hemodynamically unstable.…”

Section: Discussionmentioning

confidence: 99%

Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

Lin¹,

Stiles²,

Subramani³

et al. 2022

Cureus

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Type A aortic dissection is rare in young females; however, it is associated with a high mortality rate. This case report describes a 30-year-old female at 38 weeks of gestation who presented with acute onset chest pain and hypotension responsive to intravenous fluid therapy. Transthoracic echocardiogram and chest computed tomography angiography confirmed a type A aortic dissection. The patient was transported urgently to the operating room for a Cesarean section and aortic dissection repair. Following induction of general anesthesia, the baby was delivered, oxytocin infusion was started, and a Bakri balloon was placed in the uterus. On cardiopulmonary bypass with circulatory arrest, the ascending aorta and aortic valve were repaired. Multiple uterotonic agents were required intraoperatively to manage persistent uterine bleeding in the setting of full heparinization. Both mother and baby survived without major complications. Preoperative management should focus on maternal hemodynamic control while completing a diagnostic evaluation. Intraoperative considerations include minimizing fetal exposure to medication, maintaining hemodynamic stability, and managing intraoperative blood loss in the setting of full anticoagulation.

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“…Data on regional analgesia are extremely limited in the context of cardiac surgery, as they come from small sample sizes with high heterogeneity in techniques and the measurement of outcomes. Nevertheless, the available evidence indicates that loco-regional analgesia could facilitate enhanced recovery pathways [15,20,26,28,29,45,47]. The recent joint consensus from the ERAS Cardiac Society, the ERAS International Society and the Society of Thoracic Surgeons (STS) recommended chest wall regional analgesia as "an effective component of a multimodal approach to perioperative pain management" [29] and suggested that further research is required to establish delivery methods and the efficacy of locoregional pain control in cardiac surgery.…”

Section: Analgesia Anaesthesia and Early Extubationmentioning

confidence: 99%

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

Malvindi,

Bifulco,

Berretta

et al. 2024

JCM

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Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results. Methods: A literature search for the period January 2015 and January 2024 was performed through online databases. Clinical studies (randomised controlled trials and cohort studies) on patients undergoing heart valve surgical procedures and comparing ERAS and conventional approaches were included. The data extracted covered studies and populations characteristics, early outcomes and the features of each ERAS protocol. Results: There were 14 studies that fulfilled the final search criteria and were ultimately included in the review. Overall, 5142 patients were identified in the 14 studies, with 2501 in ERAS groups and 2641 patients who were representative of control groups. Seven experiences exclusively included patients who underwent heart valve surgery. Twelve out of fourteen protocols involved multiple interventions from the preoperative to postoperative phase, while two studies reported actions limited to intraoperative and postoperative care. We found high heterogeneity among the included protocols regarding key actions targeted for improvement and measured outcomes. All the studies showed that ERAS pathways can be safely adopted in cardiac surgery and in most of the experiences were associated with shorter mechanical ventilation time, reduced postoperative opioid use and reduced ICU and hospital stays. Conclusions: As demonstrated in noncardiac surgery, the adoption of structured ERAS protocols has the potential to improve results in patients undergoing heart valve surgery. Further evidence based on larger populations is needed, including more homogenous pathways and reporting further outcomes in terms of patient satisfaction, recovery and quality of life after surgery.

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Regional Anesthesia in Cardiac Surgery: A Review of the Literature

Cited by 8 publications

References 30 publications

Erector Spinae Plane Block for Postoperative Analgesia in Cardiac Surgeries- A Systematic Review and Meta-Analysis

Erector Spinae Plane Block for Postoperative Analgesia in Cardiac Surgeries- A Systematic Review and Meta-Analysis

Challenges for Emergent Combined Cesarean Delivery and Type A Aortic Dissection Repair Including Bleeding Management in the Setting of Full Heparinization: A Case Report

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

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