Regional anesthesia in cardiothoracic surgery: techniques, evidence, and evolving practice.

Area of Science:

• Anesthesiology and Pain Management
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Regional anesthesia has gained significant traction as an adjunct to postoperative multimodal analgesia following cardiac surgery.
• Fascial plane blocks, particularly the erector spinae plane block (introduced in 2016), are increasingly integrated into Enhanced Recovery After Surgery (ERAS) protocols.

Purpose of the Study:

• To review recent updates and advancements in regional anesthesia techniques specifically for cardiac surgery.
• To highlight the utility of these techniques within Enhanced Recovery After Cardiac Surgery (ERACS) protocols.

Main Methods:

• Review of current literature and randomized trials comparing various fascial plane blocks.
• Analysis of studies focusing on optimal block placement, dosing, and adjuvant use.

Main Results:

• Regional anesthesia adjuncts effectively reduce opioid-related side effects in cardiac surgical patients.
• Evidence suggests broader benefits, including modulation of postoperative inflammatory response, reduced risk of postoperative delirium, and potential mitigation of chronic pain syndromes.

Conclusions:

• The integration of regional analgesic techniques into multimodal pain management for cardiac surgery is expanding.
• These methods offer substantial benefits for a high-risk patient population, with ongoing research focused on refining techniques and strengthening evidence for their use.