A Review of Current Analgesic Techniques in Cardiac Surgery. Is Epidural Worth it?

Abstract

In this review we addressed the various analgesic techniques in cardiac surgery, especially regional methods such as thoracic epidural anesthesia (TEA). There are many techniques available for management of postoperative pain after cardiac operation including intravenous administration of analgesic drugs, infiltration of local anesthetics, nerve blocks, and neuroaxial techniques. Although there are many evidences declaring the benefits of neuroaxial blockade in improving postoperative well-being and quality of care in these patients, some studies have revealed limited effect of TEA on overall morbidity and mortality after cardiac surgery. On the other hand, some investigators have raised the concern about epidural hematoma in altered coagulation and risks of infection and local anesthetics toxicity during and after cardiac procedures. In present review, we tried to discuss the most recent arguments in the field of this controversial issue. The final conclusion about either using regional anesthesia in cardiac surgery or not has been assigned to the readers.

Continuous Perioperative Thoracic Epidural Fentanyl-Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer Surgeries

“…Patient-controlled epidural analgesia (PCEA) is a widely used postoperative analgesic strategy because it is very effective and safe method of acute postoperative pain relief [5]. In these surgeries Epidural analgesia is effectively applied to improve perioperative pain; epidural analgesia is coupled with improved analgesia, earlier extubation time, better hemodynamics, less respiratory complications, and superior left ventricular function [6].…”

Efectividad de la analgesia controlada por el paciente en el dolor agudo y crónico de los pacientes después de cirugía cardiaca: estudio prospectivo

“…Se han descrito otras opciones analgésicas efectivas desde un punto de vista multimodal (23,24), sin que haya suficiente evidencia para su recomendación generalizada. Se ha utilizado la analgesia epidural (25), la pregabalina (26), la oxicodona vía oral (27), la dexmedetomidina o la analgesia regional (bloqueo paravertebral (28), bloqueo intercostal o bloqueo paraesternal (29)).…”

Continuous local anaesthetic wound catheter infiltration after clamshell thoracotomy

“…The patient group undergoing emergency thoracotomy are rarely suitable for neuraxial techniques given their increased risks of trauma‐induced coagulopathy and the diagnostic challenges that provoking hypotension in the immediate peri‐operative period might cause. Various nerve blocks have been trialled, including intercostal, paravertebral and intrapleural blocks, and although effective as an adjunct to other techniques, are not as effective as a thoracic epidural analgesic strategy .…”