Pro: Regional Anesthesia for Cardiac Surgery With Sternotomy

Chronic postsurgical pain after cardiac surgery: A narrative review

Chronic postsurgical pain (CPSP) is a prevalent and debilitating sequela of cardiac surgery, exerting a profound impact on patients' quality of life, functional recovery, and healthcare systems. Its pathophysiology includes complex mechanisms, including peripheral and central sensitization, neuroplastic alterations, and inflammatory pathways, influenced by demographic, psychological, and perioperative factors. Inadequate management of acute pain is a critical contributor to its development. This review examines the etiology of CPSP, presents key risk factors, and critically evaluates pharmacological and nonpharmacological interventions. Particular attention is devoted to the role of regional anesthesia techniques and emerging preventive and therapeutic strategies, highlighting the necessity of multidisciplinary, evidence-informed approaches to address this persistent clinical challenge.

Practice Advisory for Postoperative Pain Management of Cardiac Surgical Patients: Executive Summary. A Report From the Society of Cardiovascular Anesthesiologists

Cardiac surgery is associated with significant postoperative pain that can affect patients' recovery and quality of life. Optimal analgesia after cardiac surgery can be challenging due to patients' coexisting morbidities and frequently observed adverse effects when opioids are used to treat postoperative pain. In this current era of enhanced recovery and fast track extubation, multimodal analgesia is increasingly being utilized for pain management after cardiac surgery. Regional analgesia is an integral part of multimodal analgesia and has garnered more attention since the development of fascial plane blocks. There is considerable variability among individuals, institutions, and practices in the analgesic approaches used to treat postoperative pain in cardiac surgical patients because of lack of consensus or guidelines. This practice advisory was developed with the overall goal of identifying opportunities for improving postoperative pain relief and pain-related outcomes after cardiac surgery and guiding perioperative providers through the provision of clinically relevant evidence-based recommendations.

The Effect of Perineural Adjuvants on Superficial Parasternal Intercostal Plane Blocks in Cardiac Surgery: A Triple-Blinded Randomized Controlled Feasibility Trial

Background and aim The study aimed to investigate the effect of adding perineural adjuvants, clonidine and dexamethasone, to local anesthetic in Superficial Parasternal Intercostal Plane (SPIP) blocks. It was designed as a prospective, randomized, triple-blinded, feasibility trial, conducted at a single-center university hospital. The participants included adult patients who were undergoing cardiac surgery via median sternotomy. Methodology Following skin closure, patients were randomized to receive either SPIP with 0.25% bupivacaine and 2.5 mcg/mL epinephrine (control group, n = 12) or SPIP with 0.25% bupivacaine, 2.5 mcg/mL epinephrine, 1.67 mcg/mL clonidine, and 0.1 mg/mL preservative-free dexamethasone (adjuvant group, n = 8). Results No significant difference was found between the adjuvant and control groups for the primary outcome of the area under the curve of longitudinal pain scores with incentive spirometry use measured at four timepoints during the first 24 hours following surgery (96.5 ± 58.4 vs. 94.3 ± 39.6, P = 0.93, respectively). Additionally, no difference was found for secondary outcomes, including opioid consumption in morphine milligram equivalents (120, interquartile range [IQR] 93-150 vs. 120, IQR 82-158; P = 0.88), time to extubation (232.02 ± 68.69 vs. 276.82 ± 78.61 min, P = 0.25), intensive care unit length of stay (31.4 vs. 38.2 hours, P = 0.64), or pain satisfaction scores between the adjuvant and control groups (P = 0.46), respectively. The adjuvant group demonstrated higher incentive spirometry volumes at the six-hour postoperative timepoint (1333.33 ± 857.97 mL vs. 525.00 ± 338.56 mL, P = 0.003), with a trend toward a difference at 12 and 18 hours (P = 0.24 and P = 0.10, respectively). Conclusions The addition of perineural adjuvants to SPIP was not associated with any difference in pain scores within the first 24 hours after cardiac surgery. Given the small nature of this feasibility study, further investigation is warranted.