筋膜平面阻滞作为心脏手术的局部镇痛技术:技术描述和证据更新

IF 1.6 Q2 ANESTHESIOLOGY Current Anesthesiology Reports Pub Date : 2023-09-13 DOI:10.1007/s40140-023-00576-y
Nishank P. Nooli, Jordan E. Goldhammer, Regina E. Linganna, Melody Herman, Hari Kalagara
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引用次数: 0

摘要

摘要:本文旨在综述用于心脏手术的常见筋膜平面阻滞的解剖和超声技术,以及目前可用的局部镇痛证据。在心脏手术中,与静脉止痛药或无阻滞的对照组相比,胸椎竖肌平面阻滞(ESPB)在研究中具有有益的作用。一些回顾性研究显示ESPB有不同的镇痛效果,最近的一项荟萃分析没有显示胸椎硬膜外镇痛有希望的效果。Serratus anterior plane block (SAPB)对于微创心脏手术的小胸切口是有益的,而胸骨旁阻滞(PSB)或胸骨旁肋间平面阻滞(PIP)对于胸骨切开切口是有用的。胸肌神经阻滞(PECS)也被用于各种心脏手术,在心脏起搏器和ICD手术中有很好的应用前景。在心脏手术中使用筋膜平面阻滞有增加的趋势。大多数可作为多模式镇痛的组成部分,并在心脏手术后增强恢复(ERACS)计划中发挥关键作用。选择这些筋膜平面阻滞作为省去阿片类药物的局部镇痛技术取决于切口和心脏手术类型。多种筋膜面阻滞联合使用可提高阻滞效果,但应注意限制局部麻醉的总剂量。
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Fascial Plane Blocks as Regional Analgesia Techniques for Cardiac Surgeries: a Technical Description and Evidence Update
Abstract Purpose of Review This article aims to review the anatomy and ultrasound techniques of common interfascial plane blocks used for cardiac surgeries along with the current available evidence for regional analgesia. Recent Findings Thoracic erector spinae plane block (ESPB) has a beneficial role in studies when compared with intravenous pain medications or control groups without blocks for cardiac surgeries. Some retrospective studies showed variable analgesic benefits with ESPB, and a recent meta-analysis did not show promising benefits over thoracic epidural analgesia. Serratus anterior plane block (SAPB) is beneficial with minithoractomy incisions for minimally invasive cardiac surgeries, while para sternal blocks (PSB) or parasternal intercostal plane (PIP) blocks are useful for sternotomy incisions. Pectolaris nerve blocks (PECS) have also been used for various cardiac surgeries with a promising role in cardiac pacemaker and ICD surgeries. Summary There is an increasing trend in the usage of fascial plane blocks for cardiac surgeries. Most can be used as components of multimodal analgesia and play a key role in enhanced recovery after cardiac surgery (ERACS) programs. The choice of these fascial plane blocks as opioid-sparing regional analgesia techniques depends on the incision and type of cardiac surgery. A combination of various fascial plane blocks can be used to increase the efficacy of these blocks, but caution should be exercised in limiting the total quantity of the local anesthetic administered.
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来源期刊
Current Anesthesiology Reports
Current Anesthesiology Reports Medicine-Anesthesiology and Pain Medicine
CiteScore
2.80
自引率
0.00%
发文量
47
期刊介绍: This journal aims to offer expert review articles on the most significant recent developments in the field of anesthesiology. By providing clear, insightful, balanced contributions, the journal intends to serve those involved in the delivery of anesthesia for surgical and medical procedures, treatment of acute and chronic pain conditions, perioperative management for operative and intensive care unit patients, and associated basic science and clinical research efforts in their areas. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas across the field. Section Editors select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An Editorial Board of more than 20 internationally diverse members reviews the annual table of contents, ensures that topics include emerging research, and suggests topics of special importance to their country/region. Topics covered may include ambulatory anesthesia; anesthesia and inflammation; anesthetic mechanisms; anesthetic pharmacology; cardiovascular anesthesia; critical care anesthesia; local anesthetic pharmacology; monitoring technology; neuroanesthesia; neuromuscular blockade; obstetrical anesthesia; pain mechanisms; pain therapy; patient safety; pediatric anesthesia; quality assessment; regional anesthesia; and transplantation anesthesia.
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