Abstract
In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers.
Highlights
In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA)
Pain management modalities after cardiac surgery Surgical or painful injuries initiate alteration in the nervous system that promote patho-physiologic transformation in major organs; this could lead to extensive postoperative morbidity.[14]
The evidence reveals clear advantage of performing intra-thecal or epidural anesthesia in patients undergoing cardiac surgery by better postoperative pain control, while there is no definite evidence of clinically important improvement in outcome.[83]
Summary
In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). The literature advocates that these techniques consistently provide improved postoperative analgesia with no clinically significant effect on mortality and morbidity.[9] Karagoz et al reported 5 patients undergoing single-vessel CABG through mini-thoracotomy using only high TEA while completely awake with spontaneous breathing.[10] TEA can be an alternative option to decrease the stress response of CAGB by eliminating the need for general anesthesia and mechanical ventilation.[11,12] Blockade of sympathetic nervous system in perioperative period
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