Regional anesthesia for pediatric cardiac surgery: a review

Abstract

Background: Effective pain management in pediatric cardiac surgery is essential for optimizing postoperative outcomes and promoting faster recovery. While intravenous analgesia remains a standard approach, regional anesthesia (RA) techniques have gained attention in this population due to their analgesic efficacy, reduced dependence on systemic opioids, and enhanced hemodynamic stability.

Main body: This article provides an overview of current evidence of RA techniques for pediatric cardiac surgery. We discuss the role of RA in pediatric pain management, outlining various techniques, such as epidural, paravertebral block, fascial plane blocks and their specific applications, clinical outcomes, and the challenges posed by pediatric anatomy and pharmacokinetics. Pain assessment in pediatric populations and the complications associated with RA are also explored.

Conclusion: Despite the demonstrated efficacy of RA in this patient group, there is a need for large-scale randomized multicenter studies to establish standardized protocols and strengthen the evidence base for its use in pediatric cardiac surgery.

Keywords: Cardiac Surgery; Children; Local Anesthesia; Nerve block; Pain.

Fig. 1

Schematic illustration of an ultrasound-guided erector spinae plane block

Fig. 2

Schematic illustration of the mid- transverse process to pleura and the retrolaminar block (MTPB is shown in the transverse plane for illustrative purposes; it can be better illustrated in the coronal plane between the two transverse processes.)

Fig. 3

Schematic illustration of the injection sites for local anesthetic during ultrasound-guided interpectoral and interpectoral-pectoserratus plane blocks. In the interpectoral block, the local anesthetic is injected between the pectoralis major and pectoralis minor muscles. In the interpectoral-pectoserratus plane block, local anesthetic is first injected between the pectoralis major and minor muscles (step 1), and then between the pectoralis minor and serratus anterior muscles (step 2)

Fig. 4

Schematic illustration of the injection site for local anesthetic during a serratus anterior plane block, with local anesthetic spread (blue areas) between the serratus anterior muscle and the intercostal muscles

Fig. 5

Schematic illustration of the injection sites for local anesthetic during ultrasound-guided superficial and deep parasternal intercostal plane blocks. The blue highlighted area indicates the desired spread of the local anesthetic