Abstract
With our population getting older and sicker, we are witnessing a steady increase in the volume of cardiothoracic procedures performed. As the role of anesthesiologists continues to shift towards being perioperative physicians, it is crucial to tailor the anesthetic to manage the surgical pain in both intraoperative and postoperative periods. In cardiac surgery, poorly controlled surgical pain can lead to opioid-induced hyperalgesia as well as chronic pain syndrome. As current practice encourages early extubation and decreased length of stay, clinicians have increasingly steered away from heavy intraop narcotic therapy over the past two decades. To blunt the sympathetic response and postoperative pain control, some have been using various fascial plane nerve blocks to reduce opioid use during surgery. These blocks are considered very safe to perform and do not lead to hemodynamic changes seen in neuraxial blockades. In this review article, we provide a brief overview of each of the commonly used blocks and summarize and discuss the latest clinical data for each of the common blocks and their efficacy in the setting of cardiothoracic surgery.
Highlights
BackgroundCardiovascular disease is the leading cause of mortality worldwide, accounting for approximately one-third of all deaths [1]
We provide a brief overview of each of the commonly used blocks and summarize and discuss the latest clinical data for each of the common blocks and their efficacy in the setting of cardiothoracic surgery
The amount of rescue fentanyl required was significantly higher in the intercostal group compared to serratus anterior plane (SAP) and pectoralis fascial (PECS) II groups (p
Summary
Cardiovascular disease is the leading cause of mortality worldwide, accounting for approximately one-third of all deaths [1]. Magoon et al [20] randomized 100 adults undergoing cardiac surgery via thoracotomy approach to SAP, PECS II, or intercostal nerve block groups. Nagaraja et al [28] randomized 50 patients undergoing cardiac surgery into bilateral continuous ESP and thoracic epidural groups. Sun et al [29] studied 60 patients undergoing off-pump CABG (OPCABG) comparing those with PVB combined with GA and those with GA alone They found that pain scores, morphine-equivalent consumption, and time to extubation were lower, and ICU stay was shorter in the block + GA group. The benefits of PVB over thoracic epidural include more hemodynamic stability, less nausea and vomiting, and less urinary retention while maintaining adequate pain control for cardiac surgery. Time to extubation and lengths of ICU and hospital stay were significantly decreased in the TTPM group
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