Catheter-Based Regional Anesthetic Techniques for Comprehensive Pain Management and Early Mobilization After Cardiac Sternotomy: A Report of Two Cases

Cureus, Journal Year: 2025, Volume and Issue: unknown

Published: April 4, 2025

Post-sternotomy pain management following cardiac surgery remains challenging, with both sternal incision and drain site requiring effective control. As highlighted recently, regional anesthetic techniques targeting the anterior cutaneous branches of thoracic intercostal nerves offer promising solutions for comprehensive control while reducing opioid requirements. We present two patients who underwent via sternotomy, post-operative managed using different catheter-based techniques. The first patient received bilateral deep parasternal plane block (DPIPB) catheters, second a combination superficial (SPIPB) rectointercostal fascial (RIFPB) catheter placement. Both demonstrated efficacy in managing post-sternotomy our patients. scheduled intermittent 0.25% levobupivacaine boluses provided analgesia that coincided patients' early mobilization activities, potentially contributing to their rehabilitation progress. achieved good DPIPB catheters when combined oral analgesics, patient, SPIPB as single-shot RIFPB indwelling without supplemental medications. cases highlight importance addressing epigastric pain, which often presents significant challenges management. These provide extended, adaptable during critical period after surgery, balancing safety considerations. Further research is needed compare these approaches systematically identify optimal strategies diverse surgical procedures.

Language: Английский

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Multimodal Analgesia Strategies for Cardiac Surgery: A Literature Review

Hearts, Journal Year: 2024, Volume and Issue: 5(3), P. 349 - 364

Published: Aug. 21, 2024

In cardiac surgery, poststernotomy pain is a significant issue, peaking within 48 h and requiring proper analgesia for both acute relief avoidance of chronicization. Opioids are commonly used management postsurgery but pose risks such as adverse effects dependency. Post-cardiac surgery can stem from various sources—somatic, visceral, neuropathic—making opioid reliance concern. Multimodal analgesia, which combines different medications regional anesthesia techniques, increasingly recommended to decrease use its related problems. Strategies include acetaminophen, gabapentinoids, NMDA antagonists, alpha-2 agonists, intravenous lidocaine, anti-inflammatory drugs, anesthesia. These approaches enhance control, reduce reliance, improve outcomes. The ERAS® Cardiac Society strongly advocates an opioid-sparing multimodal approach patient recovery by reducing complications increasing satisfaction. This review aims consolidate current evidence assist healthcare providers in customizing patients post-cardiac emphasizing reduced optimizing the process.

Language: Английский

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Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 601 - 601

Published: Jan. 18, 2025

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose this study evaluate and compare efficacy safety regional anesthesia (RA) using spontaneous breathing in contrast general (GA) for patients undergoing intervention TOS. Methods: We conducted a retrospective comparative involving 68 who underwent trans-axillary first rib resection patient cohort was divided into two groups: 29 GA group 39 RA group. technique employed consisted supraclavicular brachial plexus (SBP) pectoral nerve (PECS II) blocks, accompanied deep sedation. Key outcome measures such as pain scores, opioid consumption, various perioperative parameters were systematically analyzed. Results: Postoperative levels recorded recovery room significantly lower group, with median numerical rating scale (NRS) score zero compared (p = 0.0443). Additionally, both intraoperative postoperative consumption showed marked reduction p-values less than 0.001 0.0418, respectively. approach associated shorter durations 0.0008), decrease incidence nausea vomiting (PONV) 0.0312), occurrence lung injuries < 0.0001). Furthermore, length hospital stay reduced Conclusions: Although groups reported low exhibited distinct advantages terms duration, overall outcomes. utilization SBP PECS II blocks facilitated procedures mitigated complications, thereby positively influencing trajectory. Future prospective studies are essential validate these findings further investigate long-term outcomes use TOS surgery.

Language: Английский

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Evaluation of the spread and effect of local anesthetic administered using thoracic muscle plane block on internal thoracic artery grafts

Journal of Cardiothoracic and Vascular Anesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

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A year in review in Minerva Anestesiologica 2024: anesthesia, analgesia, and perioperative medicine

Minerva Anestesiologica, Journal Year: 2025, Volume and Issue: 91(3)

Published: April 1, 2025

Language: Английский

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Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era?

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(3), P. 973 - 973

Published: Feb. 3, 2025

Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following advent of intraoperative echocardiography, we are witnessing a potential new revolution for A era has indeed started implementation thoracic fascial blocks (TFBs) in field surgery. TFBs provide several advantages context multimodal analgesia, improved pain control and reduction side effects related to large doses opioids. We envisage that likely become pivotal concept enhanced recovery after describe main anterior and/or antero-lateral chest wall, their peculiar use In particular, discuss indications tips tricks enhance clinical results following blocks: (1) Pecto-Intercostal Plane (superficial deep); (2) Rectus Sheath; (3) Interpectoral Pectoserratus Plane; (4) Serratus Anterior (5) Erector Spinae Plane. Nonetheless, scientific evidence anaesthesia not robust yet, mostly based on small-sized single-centre studies, making it difficult achieve high quality evidence. Further, remains unclear which patients may benefit most from these techniques.

Language: Английский

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Bilateral parasternal and rectus sheath blocks reduce pain post-cardiac surgery: a pilot trial

Frontiers in Surgery, Journal Year: 2025, Volume and Issue: 12

Published: Feb. 20, 2025

This study aimed to investigate the effects of ultrasound-guided bilateral parasternal block (PSB) combined with rectus sheath (RSB) on postoperative recovery quality in patients undergoing median sternotomy for cardiac surgery. Eighty were randomly assigned either intervention group (receiving PSB + RSB, n = 40) or control (not receiving 40). The primary outcome was opioid consumption within first 24 h postoperatively. Secondary outcomes included Visual Analog Scale (VAS) pain scores and various surgery recovery-related parameters. showed significantly reduced postoperatively compared (P < 0.05), though no significant difference observed at 48 VAS extubation 12, 24, post-extubation lower 0.05). also demonstrated superior Quality Recovery-15 (QoR-15) all time points block-related adverse events. There differences surgical parameters between groups. Ultrasound-guided RSB effectively enhances analgesia application offers a new management strategy that is both safe highly effective. approach reduces analgesic requirements improves patients. https://www.chictr.org.cn/showproj.html?proj=180456, China Clinical Trial Registry (ChiCTR2200064733).

Language: Английский

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Recent Advances in Perioperative Analgesia in Thoracic Surgery: A Narrative Review

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 14(1), P. 38 - 38

Published: Dec. 25, 2024

Thoracic surgery is associated with significant postoperative pain, which can hinder recovery and elevate morbidity risks. Traditionally, epidural anesthesia has been the cornerstone for pain management, but its drawbacks including technical challenges, side effects, complications necessitate exploring alternative methods. This narrative review examined recent advances in perioperative analgesic strategies thoracic surgery, focusing on regional anesthetic techniques like paravertebral blocks (PVBs), erector spinae plane (ESPBs), intercostal blocks, serratus anterior blocks. Each approach was evaluated efficacy, safety, impact patient outcomes. PVB provide effective unilateral analgesia fewer systemic compared to epidurals. ESPB provides through a superficial, ultrasound-guided approach, minimizing risks offering an various procedures. Intercostal are limited by need multiple injections, increasing complication Serratus targeting nerves, show promise managing lateral wall low rate. Advancements surgical minimally invasive approaches further optimize control recovery. A multimodal combining therapies enhances outcomes addressing somatic visceral components. Despite efficacy of analgesia, offer comparable relief complications, suggesting their growing role surgery. Collaborative efforts between surgical, anesthetic, emergency teams crucial tailoring management individual patients, improving reducing long-term morbidity. Future research should continue these methods refine application broaden accessibility.

Language: Английский

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Identifying Early Risk Factors for Postoperative Pulmonary Complications in Cardiac Surgery Patients

Medicina, Journal Year: 2024, Volume and Issue: 60(9), P. 1398 - 1398

Published: Aug. 26, 2024

Background and Objectives: Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, healthcare costs. Clinical manifestations of PPCs can vary from mild severe symptoms, with different radiological findings varying incidence. Detecting early signs identifying influencing factors is essential prevent further complications. Our study aimed determine the frequency, types, risk for each PPC on first postoperative day. The main goal this was identify incidence pleural effusion (right-sided, left-sided, or bilateral), atelectasis, edema, pneumothorax well detect specific related its development. Materials Methods: This a retrospective single-center trial. It involved 314 adult scheduled elective open-heart under CPB. Results: Of reviewed, 42% developed within 12 h post-surgery. Up 60.6% experienced one PPC, while 35.6% two PPCs. Pleural most frequently observed complication 89 patients. Left-sided common, presenting 45 cases. Regression analysis showed association between left-sided development moderate hypoalbuminemia. Valve associated reduced effusion. Independent parameters bilateral include urine output longer ICU stays. Higher BMI inversely edema. Conclusions: At least almost half hypoalbuminemia factor Atelectasis second common. Bilateral third significantly output. an independent edema

Language: Английский

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Perioperative pain management for cardiac surgery

Current Opinion in Anaesthesiology, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 29, 2024

Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related the high dose opioids which have traditionally been used perioperatively in led adoption of alternative analgesic strategies. This review aims highlight current evidence-based approaches managing surgery.

Language: Английский

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