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20.03.2024 | New and Emerging Therapies in Interventional Pain Medicine (J Hasoon, Section Editor)

Neuraxial Anesthesia and Analgesia During Cardiothoracic Surgery: A Narrative Review

verfasst von: Kevin Chen, Kyle Gashler, Tommy Li, Anvinh Nguyen

Erschienen in: Current Pain and Headache Reports

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Abstract

Purpose of Review

The purpose of this review is to synthesize and examine the literature on the use of neuraxial anesthesia and analgesia during cardiothoracic surgery. As cardiothoracic procedures often require systemic anticoagulation, neuraxial techniques are quite often underutilized due to the theoretical risk of epidural hematoma. In this review, we seek to examine the literature to review the indications and contraindications and to explore if neuraxial anesthesia and analgesia has a role in cardiothoracic surgery.

Recent Findings

Neuraxial techniques have multiple advantages during cardiothoracic surgery including coronary vasodilation, decreased sympathetic surge, and a decreased cortisol level leading to overall reduction in stress response. Multiple studies have shown an improvement in pain scores, reduction in pulmonary complications, faster extubation times, with minimal complications when neuraxial techniques are utilized in cardiothoracic surgeries.

Summary

Given the numerous advantages and minimal complications of neuraxial techniques in cardiothoracic surgeries, we hope its utilization continues to increase. Moving forward, we hope additional studies continue to reaffirm the benefits of neuraxial anesthesia and analgesia for cardiothoracic surgeries to improve its utilization.
Literatur
3.
Zurück zum Zitat Kowalewski R, Seal D, Tang T, Prusinkiewicz C, Ha D. Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different? HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(1):25–8.PubMedPubMedCentral Kowalewski R, Seal D, Tang T, Prusinkiewicz C, Ha D. Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different? HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(1):25–8.PubMedPubMedCentral
5.
Zurück zum Zitat •• Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Regional analgesia for cardiac surgery part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery. Semin Cardiothorac Vasc Anesth. 2021;25(4):252–64. https://doi.org/10.1177/10892532211023337. This article discusses the utility of neuraxial and paravertebral blocks for cardiac surgery.CrossRefPubMed •• Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Regional analgesia for cardiac surgery part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery. Semin Cardiothorac Vasc Anesth. 2021;25(4):252–64. https://​doi.​org/​10.​1177/​1089253221102333​7. This article discusses the utility of neuraxial and paravertebral blocks for cardiac surgery.CrossRefPubMed
11.
Zurück zum Zitat •• Chiew JK, Low CJW, Zeng K, Goh ZJ, Ling RR, Chen Y, et al. Thoracic epidural anesthesia in cardiac surgery: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. Anesth Analg. 2023;137(3):587–600. https://doi.org/10.1213/ane.0000000000006532. This article reveals the benefits of thoracic epidural analgesia in reducing ICU/hospital length of stay and decreasing postoperative complications.CrossRefPubMed •• Chiew JK, Low CJW, Zeng K, Goh ZJ, Ling RR, Chen Y, et al. Thoracic epidural anesthesia in cardiac surgery: a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. Anesth Analg. 2023;137(3):587–600. https://​doi.​org/​10.​1213/​ane.​0000000000006532​. This article reveals the benefits of thoracic epidural analgesia in reducing ICU/hospital length of stay and decreasing postoperative complications.CrossRefPubMed
12.
Zurück zum Zitat Kowalski S, Goldie D, Maguire D, Arora RC, Girling L, Fransoo R, et al. High spinal anesthesia combined with general anesthesia versus general anesthesia alone: a retrospective cohort study in cardiac surgical patients. Acta Anaesthesiol Belg. 2019;70(2):63–70. Kowalski S, Goldie D, Maguire D, Arora RC, Girling L, Fransoo R, et al. High spinal anesthesia combined with general anesthesia versus general anesthesia alone: a retrospective cohort study in cardiac surgical patients. Acta Anaesthesiol Belg. 2019;70(2):63–70.
19.
Zurück zum Zitat • Elmiro GS, Souza AH, Loyola SO, Prudente ML, Kushida CL, Carvalho JOS, et al. Spinal anesthesia increases the frequency of extubation in the operating room and decreases the time of mechanical ventilation after cardiac surgery. Braz J Cardiovasc Surg. 2021;36(1):32–8. https://doi.org/10.21470/1678-9741-2019-0433. This article highlights the pulmonary benefits of neuraxial anesthesia in cardiac surgery.CrossRefPubMedPubMedCentral • Elmiro GS, Souza AH, Loyola SO, Prudente ML, Kushida CL, Carvalho JOS, et al. Spinal anesthesia increases the frequency of extubation in the operating room and decreases the time of mechanical ventilation after cardiac surgery. Braz J Cardiovasc Surg. 2021;36(1):32–8. https://​doi.​org/​10.​21470/​1678-9741-2019-0433. This article highlights the pulmonary benefits of neuraxial anesthesia in cardiac surgery.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Young E, Sedghi S, Farzin H, Graffeo N, Sakha H, Nader ND. Do intrathecal opioids improve surgical outcomes after coronary artery bypass grafting? A systematic review and analysis. Pain Physician. 2023;26(4):319–26.PubMed Young E, Sedghi S, Farzin H, Graffeo N, Sakha H, Nader ND. Do intrathecal opioids improve surgical outcomes after coronary artery bypass grafting? A systematic review and analysis. Pain Physician. 2023;26(4):319–26.PubMed
Metadaten
Titel
Neuraxial Anesthesia and Analgesia During Cardiothoracic Surgery: A Narrative Review
verfasst von
Kevin Chen
Kyle Gashler
Tommy Li
Anvinh Nguyen
Publikationsdatum
20.03.2024
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-024-01235-5

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