Con: Regional Anesthesia With Thoracic Fascial Plane Blocks Should Not Be Routinely Used for Cardiac Surgery

Abstract

REGIONAL ANESTHESIA in the form of thoracic fascial plane blocks is a relatively new phenomena within the world of cardiac surgery. Historically, high-dose opioids were used to allow for a controlled hemodynamic response during induction and times of extreme stimulation such as incision and sternotomy. In present day trends of Enhanced Recovery after Surgery, fast-track extubation, and opioid reduction, regional anesthesia for cardiac surgery has received a lot of attention. 1 Kelava M Alfirevic A Bustamante S et al. Regional anesthesia in cardiac surgery: An overview of fascial plane chest wall blocks. Anesthesia & Analgesia. 2020; 131: 127-135 Crossref PubMed Scopus (67) Google Scholar Despite the initial allure, the evidence in support of regional anesthesia over multimodal adjuncts is inconsistent and less than compelling. Furthermore, safety and efficiency concerns regarding regional anesthesia are not uncommon and need to be considered. Despite the current trend, the authors feel the current body of evidence does not support routine use of regional anesthesia for cardiac surgery.