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

There has been a proliferation of academic and clinical interest in regional anesthesia as an adjunct for postoperative multimodal analgesia after cardiac surgery over the last decade. Since the introduction of the erector spinae plane block in 2016, fascial plane block use has rapidly expanded as a component of Enhanced Recovery After Surgery protocols. This review serves to highlight updates and advancements in regional anesthesia with a focus on cardiac surgery and its utility in Enhanced Recovery After Cardiac Surgery protocols.

Regional anesthesia techniques continue to be refined in their application for cardiac surgery. Emphasis has been placed on identifying ideal block placement, ideal block dosing, ideal dosing intervals, and even ideal adjuvants. Randomized trials have been performed comparing different fascial plane blocks against others or sham blocks. Evidence suggests that in addition to reducing the side effects of opioid use in this patient population, regional adjuncts for pain control in cardiac surgical patients may have wider implications, including postoperative inflammatory response, postoperative delirium, and risk of developing chronic pain syndromes.

The integration of regional analgesic techniques into multimodal pain regimens for cardiac surgery will only continue to grow. These techniques have been shown to have a wide range of benefits for a vulnerable and high-risk patient population. Ongoing studies aim to refine these techniques and increase the evidence for their utilization.