Multimodal Analgesia for Cardiothoracic Procedures: Nonpharmacological and Alternative Pain Management Techniques:...

Although thoracic epidural analgesia and paravertebral blocks have well-documented benefits in cardiac surgery, the theoretical risk of neuraxial hematoma in anticoagulated patients limits their use. Fascial plane blocks are recently described techniques in regional anesthesia that have provided relatively safe and efficacious alternatives to treating postoperative pain following cardiac surgery. There are techniques such as erector spinae plane blocks, deep and superficial parasternal intercostal blocks, and serratus anterior plane blocks. Alternative therapies, such as transcutaneous electrical nerve stimulation, acupuncture, cryoablation, ascorbic acid, magnesium, and turmeric, have shown some promise as adjunctive pain therapies but need to be studied in further detail.