Jiang Tianyu, Ting Andrewston, Leclerc Michael, Calkins Kerry, Huang Jeffrey
Anesthesiology, Oak Hill Hospital, Brooksville, USA.
College of Medicine, University of South Florida, Tampa, USA.
Cureus. 2021 Oct 15;13(10):e18808. doi: 10.7759/cureus.18808. eCollection 2021 Oct.
With our population getting older and sicker, we are witnessing a steady increase in the volume of cardiothoracic procedures performed. As the role of anesthesiologists continues to shift towards being perioperative physicians, it is crucial to tailor the anesthetic to manage the surgical pain in both intraoperative and postoperative periods. In cardiac surgery, poorly controlled surgical pain can lead to opioid-induced hyperalgesia as well as chronic pain syndrome. As current practice encourages early extubation and decreased length of stay, clinicians have increasingly steered away from heavy intraop narcotic therapy over the past two decades. To blunt the sympathetic response and postoperative pain control, some have been using various fascial plane nerve blocks to reduce opioid use during surgery. These blocks are considered very safe to perform and do not lead to hemodynamic changes seen in neuraxial blockades. In this review article, we provide a brief overview of each of the commonly used blocks and summarize and discuss the latest clinical data for each of the common blocks and their efficacy in the setting of cardiothoracic surgery.
随着我们的人口老龄化和病情加重，我们目睹了心胸外科手术量的稳步增长。随着麻醉医生的角色不断向围手术期医生转变，根据手术情况调整麻醉方案以在术中和术后管理手术疼痛至关重要。在心脏手术中，手术疼痛控制不佳可导致阿片类药物诱导的痛觉过敏以及慢性疼痛综合征。由于目前的做法鼓励早期拔管并缩短住院时间，在过去二十年中，临床医生越来越少使用强效术中麻醉疗法。为了抑制交感神经反应和控制术后疼痛，一些人一直在使用各种筋膜平面神经阻滞来减少手术期间的阿片类药物使用。这些阻滞被认为实施起来非常安全，不会导致在神经轴阻滞中出现的血流动力学变化。在这篇综述文章中，我们简要概述了每种常用的阻滞方法，并总结和讨论了每种常见阻滞方法的最新临床数据及其在心胸外科手术中的疗效。
