Fascial Plane Blocks as Regional Analgesia Techniques for Cardiac Surgeries: a Technical Description and Evidence Update

Abstract

Abstract Purpose of Review This article aims to review the anatomy and ultrasound techniques of common interfascial plane blocks used for cardiac surgeries along with the current available evidence for regional analgesia. Recent Findings Thoracic erector spinae plane block (ESPB) has a beneficial role in studies when compared with intravenous pain medications or control groups without blocks for cardiac surgeries. Some retrospective studies showed variable analgesic benefits with ESPB, and a recent meta-analysis did not show promising benefits over thoracic epidural analgesia. Serratus anterior plane block (SAPB) is beneficial with minithoractomy incisions for minimally invasive cardiac surgeries, while para sternal blocks (PSB) or parasternal intercostal plane (PIP) blocks are useful for sternotomy incisions. Pectolaris nerve blocks (PECS) have also been used for various cardiac surgeries with a promising role in cardiac pacemaker and ICD surgeries. Summary There is an increasing trend in the usage of fascial plane blocks for cardiac surgeries. Most can be used as components of multimodal analgesia and play a key role in enhanced recovery after cardiac surgery (ERACS) programs. The choice of these fascial plane blocks as opioid-sparing regional analgesia techniques depends on the incision and type of cardiac surgery. A combination of various fascial plane blocks can be used to increase the efficacy of these blocks, but caution should be exercised in limiting the total quantity of the local anesthetic administered.