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Review
. 2023 Jun 1;36(3):324-333.
doi: 10.1097/ACO.0000000000001262. Epub 2023 Mar 13.

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

Tomohiro Yamamoto  1 , Ehrenfried Schindler  2
Affiliations
Review

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

Tomohiro Yamamoto et al. Curr Opin Anaesthesiol. .

Abstract

Purpose of review: The purpose of this review article was to highlight the enhanced recovery protocols in pediatric cardiac surgery, including early extubation, rapid mobilization and recovery, reduction of opioid-related side effects, and length of pediatric ICU and hospital stay, resulting in decreased costs and perioperative morbidity, by introducing recent trends in perioperative anesthesia management combined with peripheral nerve blocks.

Recent findings: Efficient postoperative pain relief is essential for realizing enhanced recovery strategies, especially in pediatric patients. It has been reported that approaches to perioperative pain management using additional peripheral nerve blocks ensure early extubation and a shorter duration of ICU and hospital stay. This article provides an overview of several feasible musculofascial plane blocks to achieve fast-track anesthesia management for pediatric cardiac surgery.

Summary: Recent remarkable advances in combined ultrasound techniques have made it possible to perform various peripheral nerve blocks. The major strategy underlying fast-track anesthesia management is to achieve good analgesia while reducing perioperative opioid use. Furthermore, it is important to consider early extubation not only as a competition for time to extubation but also as the culmination of a qualitative improvement in the outcome of treatment for each patient.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Schema of access points to the intercostal nerve blocks for perioperative pain management for cardiac surgery. Blocking the intercostal nerve at any approachable site is the theory of peripheral nerve block for cardiac surgery with median sternotomy as well as intercostal approach.
FIGURE 2
FIGURE 2
Erector spinae plane block performed in a blinded fashion in a lateral position. Erector spinae plane block (ESPB) and retrolaminar block (RLB) can also be performed in a blinded fashion by injecting a local anesthetic at the point where the puncture needle is applied to the transverse process of the vertebra.
See this image and copyright information in PMC

References

    1. Mondal S, Bergbower EAS, Cheung E, et al. . Role of cardiac anesthesiologists in intraoperative Enhanced Recovery After Cardiac Surgery (ERACS) Protocol: a retrospective single-center study analyzing preliminary results of a yearlong ERACS protocol implementation. J Cardiothorac Vasc Anesth 2022. - PubMed
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    1. Fuller S, Kumar SR, Roy N, et al. . AATS Cardiac Clinical Practice Standards Committee Members. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162:931–954. - PubMed
    1. Bignami E, Castella A, Allegri M. Postoperative pain after cardiac surgery: an open issue. J Cardiothorac Vasc Anesth 2018; 32:e24–e25. - PubMed

    2. This article provides the background that led to the writing of this review article by describing the current status of limited postoperative pain management after cardiac surgery.

    1. Abadi A, Cohen R. Evaluation of an enhanced recovery after surgery protocol including parasternal intercostal nerve block in cardiac surgery requiring sternotomy. Am Surg 2021; 87:1561–1564. - PubMed

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