From the Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Anesth Analg. 2020 Jul;131(1):127-135. doi: 10.1213/ANE.0000000000004682.
Optimal analgesia is an integral part of enhanced recovery after surgery (ERAS) programs designed to improve patients' perioperative experience and outcomes. Regional anesthetic techniques in a form of various fascial plane chest wall blocks are an important adjunct to the optimal postoperative analgesia in cardiac surgery. The most common application of fascial plane chest wall blocks has been for minimally invasive cardiac surgical procedures. An abundance of case reports has been described in the anesthesia literature and reports appear promising, yet higher-level safety and efficacy evidence is lacking. Those providing anesthesia for minimally invasive cardiac procedures should become familiar with fascial plane anatomy and block techniques to be able to provide enhanced postsurgical analgesia and facilitate faster functional recovery and earlier discharge. The purpose of this review is to provide an overview of contemporary fascial plane chest wall blocks used for analgesia in cardiothoracic surgery. Specifically, we focus on relevant anatomic considerations and technical descriptions including pectoralis I and II, serratus anterior, pectointercostal fascial, transverse thoracic muscle, and erector spine plane blocks. In addition, we provide a summary of reported local anesthetic doses used for these blocks and a current state of the literature investigating their efficacy, duration, and comparisons with standard practices. Finally, we hope to stimulate further research with a focus on delineating mechanisms of action of novel emerging blocks, appropriate dosing regimens, and subsequent analysis of their effect on patient outcomes.
优化的镇痛是增强术后恢复（ERAS）计划的一个组成部分，旨在改善患者的围手术期体验和结果。以各种筋膜平面胸壁阻滞形式的区域麻醉技术是心脏手术中优化术后镇痛的重要辅助手段。筋膜平面胸壁阻滞最常见的应用是微创心脏手术。麻醉文献中已经描述了大量的病例报告，并且报告显示有前景，但缺乏更高水平的安全性和疗效证据。那些为微创心脏手术提供麻醉的人应该熟悉筋膜平面解剖和阻滞技术，以便能够提供增强的术后镇痛，促进更快的功能恢复和更早的出院。本综述的目的是提供一个用于心胸外科手术镇痛的当代筋膜平面胸壁阻滞概述。具体来说，我们重点介绍了相关的解剖学考虑因素和技术描述，包括胸大肌 I 型和 II 型、前锯肌、胸肌肋间筋膜、胸横肌和竖脊肌平面阻滞。此外，我们还总结了这些阻滞中使用的局部麻醉剂剂量，并介绍了目前关于其疗效、持续时间以及与标准实践比较的文献状况。最后，我们希望通过专注于描绘新出现的阻滞的作用机制、适当的剂量方案以及随后分析它们对患者结局的影响来激发进一步的研究。
