Regional Anesthesia for Cardiac Surgery

Abstract

Cardiac surgery is associated with significant postoperative pain, regardless of surgical approach. Median sternotomy and thoracotomy are particularly traumatic, resulting in pain that typically lasts weeks and may lead to chronic pain syndromes. Even newer minimally invasive procedures involving mini-thoracotomy and other smaller incisions are not pain-free, while the presence of chest tubes also causes significant discomfort. Uncontrolled pain following cardiac surgery contributes to adverse outcomes, particularly pulmonary complications and prolonged lengths of stay. Intravenous opiates alone or in combination with other sedatives are imperfect solutions to this problem as they are associated with excess sedation, nausea, vomiting, pruritis, delirium, constipation, and dependence. In recent years, regional anesthesia techniques have increasingly been utilized for cardiac surgery as part of enhanced recovery after cardiac surgery pathways. In many cases, techniques that were developed for other surgical procedures, particularly breast surgery, have been applied to the cardiac surgical population with favorable results. However, many practicing cardiac anesthesiologists have limited experience with these regional anesthesia techniques, so implementing them into clinical practice effectively can be challenging. This chapter aims to address this gap by reviewing the evidence, techniques, and applicability of the regional anesthesia approaches appropriate for cardiac surgery patients.