Regional analgesia for minimally invasive cardiac surgery.

Background: Minimally invasive cardiac surgery (MICS) has expanded during the recent years due to interest in improved patient satisfaction and decreased stay in the hospital. To assist in these interests, postoperative pain control is aimed at decreasing opioid usage but maintaining adequate pain control. Regional anesthesia has the ability to provide these goals. This review article will describe different regional anesthesia techniques and discuss the evidence of their use in MICS.

Methods: A literature search was conducted in MEDLINE (PubMed) and EMBASE with keywords and narrowed to publications between 1998 and 2018. The results are reviewed, analyzed, and discussed in this paper.

Results: Thoracic epidurals provide improved pain control and decreased stay in the intensive care unit. Thoracic paravertebral blocks are as effective as thoracic epidurals for postoperative pain control. Serratus anterior plane block provides adequate pain control but does not control pain as well as paravertebral blocks. Intrapleural blocks provide sufficient pain control and can be placed by the surgeon. Pectoral fascial blocks, intercostal blocks, and erector spinae plane blocks described in case reports seem to be viable options for postoperative pain control.

Conclusions: As cardiac surgery moves toward smaller incisions and MICS with the goal of enhanced recovery, multimodal analgesic techniques should be explored for postoperative pain control. The regional techniques discussed in this article show a trend toward improved pain control and decreased stay in the intensive care unit.