Regional Anesthesia & Pain Medicine,
Journal Year:
2024,
Volume and Issue:
unknown, P. rapm - 105736
Published: Nov. 5, 2024
Background
While
superficial
parasternal
intercostal
plane
blocks
can
improve
analgesia
after
cardiac
surgery,
the
optimal
site
and
number
of
injections
remain
uncertain.
This
study
aimed
to
compare
efficacy
single
versus
double
blocks,
hypothesizing
that
would
achieve
superior
cutaneous
sensory
blockade.
Methods
70
patients
undergoing
median
sternotomy
were
randomly
assigned
receive
either
or
bilaterally.
Each
patient
received
40
mL
0.25%
bupivacaine
with
epinephrine
5
µg/mL
dexamethasone
10
mg.
The
single-injection
group
20
mL/side
at
third
costal
cartilage,
while
double-injection
mL/injection
second
fourth
cartilages.
primary
outcome
was
a
successful
block,
defined
as
loss
in
T2–T6
dermatomes.
Secondary
outcomes
included
block
T1,
T7,
T8
dermatomes,
block-related
complications,
intraoperative
hemodynamics,
postoperative
pain
intensity,
opioid
consumption,
recovery
quality.
Results
Double
achieved
an
overall
higher
success
rate
compared
technique
(81%
vs
51%,
relative
risk
1.6;
95%
CI
1.2,
2.0;
p<0.001).
Additionally,
blockade
percentages
observed
dermatomes
T1
(83%
59%,
p=0.003),
T7
(67%
46%,
p=0.017),
(61%
39%,
p=0.011)
injections.
Other
secondary
did
not
differ
significantly
between
groups.
Conclusions
Compared
injection,
provided
more
reliable
coverage
crucial
for
sternotomy.
However,
no
differences
hemodynamic
effects
control
surgery.
Trial
registration
TCTR20230408004.
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.
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.
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.
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.
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).
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.
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
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.