Ultrasound-Guided Regional Anesthesia-Current Strategies for Enhanced Recovery after Cardiac Surgery.

Cosmin Balan,Dana Rodica Tomescu,Serban-Ion Bubenek-Turconi,Liana Valeanu

doi:10.3390/medicina57040312

Abstract

With the advent of fast-track pathways after cardiac surgery, there has been a renewed interest in regional anesthesia due to its opioid-sparing effect. This paradigm shift, looking to improve resource allocation efficiency and hasten postoperative extubation and mobilization, has been pursued by nearly every specialty area in surgery. Safety concerns regarding the use of classical neuraxial techniques in anticoagulated patients have tempered the application of regional anesthesia in cardiac surgery. Recently described ultrasound-guided thoracic wall blocks have emerged as valuable alternatives to epidurals and landmark-driven paravertebral and intercostal blocks. These novel procedures enable safe, effective, opioid-free pain control. Although experience within this field is still at an early stage, available evidence indicates that their use is poised to grow and may become integral to enhanced recovery pathways for cardiac surgery patients.

Highlights

Cardiac surgery (CS) generates a unique set of challenges compared to non-cardiac surgery
Postoperative outcomes and quality of life result from several factors, including demographic characteristics, comorbidities, type and quality of surgical intervention, the extent of the systemic inflammatory response, range of organ dysfunction and pain [1,2,3,4]
The scope of this review is to address the use of Regional anesthesia/analgesia (RA) in CS, with particular reference to the indications, techniques, and complications of currently available chest wall fascial plane blocks (CWFPB)

Summary

Introduction

Cardiac surgery (CS) generates a unique set of challenges compared to non-cardiac surgery. Postoperative outcomes and quality of life result from several factors, including demographic characteristics, comorbidities, type and quality of surgical intervention, the extent of the systemic inflammatory response, range of organ dysfunction and pain [1,2,3,4] Many of these factors are amenable to optimization. Regional anesthesia/analgesia (RA) represents a valid alternative for the MA repertoire It obviates many of the drawbacks of drug-based MA strategies, albeit with its particular challenges [10]. Classical neuraxial techniques such as thoracic epidural anesthesia (TEA) and landmark-based paravertebral blocks (PVBLM) constituted the standard regional approach to ensure chest wall pain relief before ultrasound (US) virtually revolutionized RA.

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Conclusions