Future of Awake Cardiac Surgery

Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia?

“…Till such time, it is unlikely that central neuraxial blocks would make a comeback in patients receiving dual antiplatelet medications. [ 2 ] In addition, use of local anesthetic agents to provide postoperative analgesia instead of opioids in tandem provides a vista of opportunity to reduce or avoid opioid use and move toward opioid-free anesthesia (OFA).…”

Pectointercostal Fascial Block (PIFB) as a Novel Technique for Postoperative Pain Management in Patients Undergoing Cardiac Surgery

“…Regional anesthesia techniques confer better hemodynamic stability, perioperative analgesia, attenuation of surgical stress response, early extubation, improved pulmonary function, and decreased cognitive dysfunction. 21 Minimally invasive cardiac surgery, using fascial plane blocks as a sole anesthetic technique, can be the best regimen an anesthesiologist can provide for the patient. PIFB, in comparison to other fascial plane blocks, has certain advantages and disadvantages.…”

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

“…152 However, whether regional anesthesia is superior to general anesthesia in terms of survival and major postoperative outcomes, and accordingly should be preferred whenever possible, is a matter of longstanding debate that continuously feeds on new conflicting evidences. [165][166][167] Although cardiac interventions, mainly single-vessel OPCAB procedures, performed in awake patients under high thoracic epidural anesthesia (TEA) have been described, [168][169][170][171] cardiac surgery is almost universally performed with the patient under general anesthesia with tracheal intubation, if only for the increasingly widespread use of intraoperative transesophageal echocardiography as one of the most "modern" reasons that impose such a strategy. Associating neuraxial anesthesia/analgesia with general anesthesia in patients undergoing cardiac surgery may have several (theoretical) advantages, but also it raises actual organizational and safety issues.…”