Cleveland Clinic Foundation, Cleveland, OH, USA.
Washington University at St Louis, St Louis, MO, USA.
Semin Cardiothorac Vasc Anesth. 2021 Dec;25(4):265-279. doi: 10.1177/10892532211002382. Epub 2021 Apr 8.
The introduction of regional analgesia in the past decades have revolutionized postoperative pain management for various types of surgery, particularly orthopedic surgery. Nowadays, they are being constantly introduced into other types of surgeries including cardiac surgeries. Neuraxial and paravertebral plexus blocks for cardiac surgery are considered as deep blocks and have the risk of hematoma formation in the setting of anticoagulation associated with cardiac surgeries. Moreover, hemodynamic compromise resulting from sympathectomy in patients with limited cardiac reserve further limits the use of neuraxial techniques. A multitude of fascial plane blocks involving chest wall have been developed, which have been shown the potential to be included in the regional analgesia armamentarium for cardiac surgery. In myofascial plane blocks, the local anesthetic spreads passively and targets the intermediate and terminal branches of intercostal nerves. They are useful as important adjuncts for providing analgesia and are likely to be included in "Enhanced Recovery after Cardiac Surgery (ERACS)" protocols. There are several small studies and case reports that have shown efficacy of the regional blocks in reducing opioid requirements and improving patient satisfaction. This review article discusses the anatomy of various fascial plane blocks, mechanism of their efficacy, and available evidence on outcomes after cardiac surgery.
在过去几十年中，区域麻醉的引入彻底改变了各种类型手术（尤其是骨科手术）的术后疼痛管理方式。如今，它们不断被引入其他类型的手术，包括心脏手术。心脏手术中的神经轴和椎旁丛阻滞被认为是深部阻滞，并且在与心脏手术相关的抗凝治疗中存在血肿形成的风险。此外，由于交感神经切除术导致心脏储备有限的患者出现血液动力学障碍，进一步限制了神经轴技术的使用。已经开发出了许多涉及胸壁的筋膜平面阻滞，它们具有被纳入心脏手术区域镇痛手段的潜力。在肌筋膜平面阻滞中，局部麻醉剂被动扩散并靶向肋间神经的中间和末端分支。它们作为提供镇痛的重要辅助手段非常有用，并且可能被纳入“心脏手术后加速康复（ERACS）”方案中。有几项小型研究和病例报告表明，这些区域阻滞在减少阿片类药物需求和提高患者满意度方面具有疗效。这篇综述文章讨论了各种筋膜平面阻滞的解剖结构、其疗效机制以及心脏手术后的结果方面的现有证据。
