Central neuraxial analgesia in cardiac surgery

An ideal anesthetic for cardiac surgery should provide intraoperative cardiovascular stability and a stable and pain-free recovery. High-dose narcotics, whether given as an initial bolus or by the continuous infusion method, certainly have brought current practice closer to this ideal. Central neuraxial analgesia is an alternative to high-dose narcotics, but its use has long been an issue of debate and concern in cardiac surgery. The need for full heparinization for cardiopulmonary bypass has curtailed the use of central neuraxial blocks. Until fairly recently, very few centers dared to attempt this kind of effective analgesia in cardiac surgery. However, during the last few years more and more reports have been published on the efficacy and safety of this type of analgesia when appropriate precautions are taken. The objective of this report is to examine some of these issues.