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Perioperative Pain Management of Patients Presenting for Cardiac Surgery 347
serious side effects following on-pump cardiac surgery [63]. Another study demon-
strated a decreased time to extubation and decreased postoperative pain scores
with magnesium sulfate administration during elective CABG surgery [64]. These
studies demonstrate promise for magnesium as a non-opioid analgesic, but further
high-quality studies are necessary to draw firm conclusions.
Intravenous Lidocaine
Perioperative infusions of intravenous lidocaine have been shown to improve pain
control after certain types of surgery. The mechanism of action for intravenous lido-
caine in improving perioperative pain control is complex and still being fully eluci-
dated but is felt to be related to its ability to attenuate the proinflammatory effects of
surgery rather than its effect on sodium channels [65]. Lidocaine infusions utilized for
abdominal surgery have been found to reduce pain scores and postoperative opioid
requirements [66]. Doses greater than or equal to 2 mg/kg/h were associated with
decreased pain scores and opioid consumption in the first 24 h, however smaller
doses were not. There is evidence that perioperative lidocaine administration may
decrease the duration of ileus and decrease the incidence of postoperative nausea
and vomiting [67]. In addition, toxicity related to the use of perioperative lidocaine
infusions appears to be exceedingly rare [68]. The data for the use of periopera-
tive lidocaine infusions in the setting of cardiac surgery is not as supportive. Insler
et al. found no difference in pain scores or opioid consumption in cardiac surgery
patients receiving an intraoperative lidocaine infusion [69]. However, Wang et al.
did demonstrate a lower incidence of postoperative cognitive dysfunction in cardiac
surgery patients receiving an intraoperative lidocaine infusion [70].Basedonthis
limited data, perioperative lidocaine infusions are not currently recommended for
analgesia in cardiac surgery patients. Given the positive data in other surgical popu-
lations, further study may help define a role for this adjunct in the future in t he cardiac
surgery patient.
6 Regional Techniques
Multimodal analgesia techniques with regional anesthesia are becoming increasingly
popular for ERAS to improve patient outcomes and satisfaction. Historically,regional
techniques in cardiac surgery consisted of thoracic epidurals, paravertebral blocks,
and intercostal blocks. However, with the introduction of and increased availability
of ultrasound imaging, there are various fascial plane blocks that may now represent
reasonable analgesic options for cardiac surgeries.
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348 E. R. Simon et al.
Thoracic Wall Innervation
Understanding the anatomy of the thoracic wall and its innervation is crucial to
understanding the regional interventions available for the cardiac surgery patient.
The thoracic wall is primarily innervated by the intercostal nerves, which derive
from the anterior rami of spinal nerves T1-11. The intercostal nerves run between
adjacent ribs. The anterior ramus of T12 is a subcostal nerve because it enters the
abdominal wall [71, 72]. The typical intercostal nerve traverses laterally behind the
sympathetic trunk, entering the intercostal space between the parietal pleura and
intercostal membrane. In the costal groove, it runs with the intercostal vessels. Near
the midaxillary line, the lateral cutaneous branches emerge. The lateral cutaneous
branch pierces through the muscles of the lateral thoracic wall to divide into anterior
and posterior branches and innervate the skin of the lateral thoracic wall. Near the
sternum, the intercostal nerves cross anterior to the internal thoracic artery to become
anterior cutaneous branches. The anterior cutaneous branch is the terminal branch.
It divides into medial and lateral branches to supply sensory innervation to the skin
of the anterior thoracic wall [71, 72].
Thoracic Epidural Analgesia
Thoracic epidural analgesia (TEA) has been considered the gold standard for post-
operative pain management after thoracic surgeries. Epidural analgesia can also
be beneficial for cardiac surgery. However, utilization is controversial due to the
theoretical increased risk of epidural hematoma and consequent neurologic damage
associated with full systemic heparinization for cardiopulmonary bypass. There is
also a risk of hypotension from the sympathectomy that may compromise cardiac
perfusion. Sympathectomy and resulting afterload reduction may be specifically
contraindicated in patients with severe aortic stenosis or hypertrophic cardiomy-
opathy. Despite concerns, epidural analgesia may reduce the risk of postoperative
complications, such as pneumonia, respiratory failure, myocardial infarction, renal
injury, arrhythmias, decrease mechanical ventilation time, and decrease the amount
of time that patients spend in the ICU. Epidural analgesia may also attenuate the
surgical inflammatory response and provide cardioprotective effects by increasing
myocardial oxygen availability and decreasing myocardial oxygen consumption due
to the sympathectomy [73, 74].
In a 2019 Cochrane review, it was concluded that thoracic epidural analgesia does
not change the risk of mortality or pneumonia compared to systemic analgesia in
cardiac surgery [73]. Epidural analgesia may decrease the risk of myocardial infarc-
tion, respiratory depression, and atrial arrhythmias, reduce the duration of tracheal
intubation, and decrease pain scores at 6, 24, 48, and 72 h following surgery. Epidural
analgesia may increase the risk of hypotension and the need for vasopressor boluses,
but there is no difference in vasopressor infusions. No increased risk for epidural
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Perioperative Pain Management of Patients Presenting for Cardiac Surgery 349
hematoma was found, however, there were not enough participants to sufficiently
evaluate the risk of hematoma formation following epidural catheter placement. The
American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines
are limited by insufficient available data to determine the increased risk of neuraxial
hematoma formation encountered when using neuraxial techniques with full anti-
coagulation required for cardiac surgery. Perioperative anticoagulation guidelines
provided by ASRA are intended to apply to neuraxial and deep blocks including
paravertebral blocks [73].
Paravertebral Block
The thoracic paravertebral space is located on either side of the vertebral column.
The anterolateral boundary is formed by the parietal pleura, the base is formed by the
vertebral body, intervertebral disc, and the intervertebral foramen, and the posterior
boundary is formed by the transverse process and superior costotransverse ligament.
A paravertebral block (PVB) produces an ipsilateral motor, sensory, and sympathetic
nerve block by anesthetizing the intercostal nerves in the paravertebral space, as well
as local anesthetic extension into the intercostal space laterally and epidural space
medially [75].
There are various ultrasound-guided PVB techniques, including transverse or
sagittal transducer orientation and in-plane or out-of-plane approaches. In general, the
needle will be directed between adjacent transverse processes and traverse the supe-
rior costotransverse ligament with anterior deflection of the parietal pleura observed
when local anesthetic is injected into the paravertebral space. The block level should
be near the dermatome for the incision and either multiple levels or a single injection
of a larger volume of local anesthetic can be performed to cover the desired area of
analgesia [75].
PVBs may be beneficial for minimally invasive procedures, thoracotomy inci-
sions as well as midline sternotomy incisions given the location of neural blockade.
Complications following paravertebral blockade include vascular puncture, hypoten-
sion, pleural puncture, pneumothorax, inadvertent epidural or spinal anesthesia, and
local anesthetic systemic toxicity (LAST). PVBs are considered a deep block and
are therefore subject to the same anticoagulation guidelines as those that exist for
epidural catheter placement [75].
There are limited studies evaluating the role of PVBs in cardiac surgery. The few
studies that are available have demonstrated that bilateral PVBs can be effective and
safe. The use of PVBs can facilitate early extubation and decrease opioid usage [76–
78]. They have been shown to reduce pain scores, decrease intraoperative opioid use,
facilitate extubation, and provide similar analgesia to epidurals [79]. Studies have also
shown that PVBs can decrease the incidence of nausea, vomiting, hypotension, and
urinary retention [80, 81]. PVBs are becoming more popular for minimally invasive
cardiac surgery through a thoracotomy or video-assisted thoracoscopic approach.
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Pectoralis I and II Blocks
Pectoralis I (Pecs I) nerve block involves depositing local anesthetic between the
pectoralis major and pectoralis minor muscles to block the lateral and medial pectoral
nerves, which innervate the pectoralis muscles. Pectoralis II (Pecs II) nerve blocks
involves depositing local anesthetic between the pectoralis muscles and a second
injection between the pectoralis minor and serratus anterior muscles. Pecs II blocks
the pectoral nerves, upper intercostal (3–6) nerves, as well as the intercostobrachial,
thoracodorsal and long thoracic nerves.
These nerve blocks are performed in-plane with needle trajectory medial to lateral.
The ultrasound transducer is positioned sagittal with an inferolateral angle at the
midclavicular area. The transducer is then moved laterally to obtain the appropriate
images. Pecs I is performed at the level of ribs 2–3. The first injection of Pecs II is
similar to Pecs I, while the second injection is at the anterior axillary line at the level
of the fourth rib [82].
Pecs I use is limited and primarily for more superficial, anterior chest wall surg-
eries that include disruption of the pectoralis muscles (i.e. placement of a submus-
cular ICD). Pecs II is more useful in the setting of cardiac procedures and may be
utilized to provide analgesia for anterolateral chest surgeries, such as breast surgery,
subcutaneous implantable cardiac defibrillators (SICD), video assisted thoracoscopic
surgery (VATS), and anterior thoracotomies. Pecs blocks do not anesthetize anterior
cutaneous branches and therefore may be better indicated for antero-lateral inci-
sions and procedures. Complications are rare but include pneumothorax, infection,
vascular puncture, and local anesthetic systemic toxicity [82].
There have been limited studies on Pecs blocks in the setting of cardiac surgery.
These blocks are performed in a supine position so they can be useful as rescue
blocks in patients who have limited mobility secondary to lines, chest tubes, and
mechanical ventilation. A study of 40 patients undergoing coronary artery bypass
grafting or valve surgeries via midline sternotomy found that bilateral Pecs II blocks
helped with early extubation, improved pain scores at rest and with cough, and
improved incentive spirometry flow rates compared with no Pecs blocks [81, 83].
Serratus Anterior Plane Block
The serratus anterior plane (SAP) block can be performed superficially or deep
to the serratus anterior muscle to anesthetize the anterolateral chest wall (T2–9
dermatomes). This block targets the lateral cutaneous branches of the thoracic inter-
costal nerves as well as intercostobrachial, long thoracic, and thoracodorsal nerves.
At the level of the fifth rib, the superficial plane is formed by the anterior aspect of
the serratus anterior muscle and the posterior aspect of the latissimus dorsi muscle.
The deep plane is formed by the posterior aspect of the serratus anterior muscle and
the external intercostal muscles and ribs [84].
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Perioperative Pain Management of Patients Presenting for Cardiac Surgery 351
The SAP block is performed at the level of the fifth rib around the midaxillary
line. The transducer is oriented in the coronal plane and tilted posteriorly to identify
the latissimus dorsi lying superficial to the serratus anterior muscle. An in-plane
technique is used with anterior to posterior needle trajectory and local anesthetic can
be injected above or below the serratus anterior muscle [84].
Common indications for the SAP block include lateral rib fractures, VATS,
thoracotomy, SICD placement, and breast surgery. Complications are rare but
include pneumothorax in addition to other known complications inherent to regional
techniques [84].
This block spares the midline chest area; thus, no studies have been performed
for sternotomies. Two studies have shown that this block can be safe and efficacious
in cardiac device implantation [81]. Several studies found that this block can reduce
pain scores and opioid consumption for minimally invasive cardiac surgery [85–87].
Erector Spinae Plane Block
The erector spinae plane (ESP) block is a paraspinal fascial plane block where l ocal
anesthetic is injected between the erector spinae muscle and thoracic transverse
processes. The mechanism of action is not fully understood. It blocks the dorsal and
ventral rami of the thoracic spinal nerves for multi-dermatomal sensory block of
anterior, posterior, and lateral thoracic walls. Local anesthetic may also diffuse into
the paravertebral and epidural spaces [88].
The ESP block can be performed at either a single level or multiple levels for
adequate analgesic coverage. The block spreads over multiple vertebral levels and
therefore a single injection of a large volume of local anesthetic may provide diffuse
analgesia. The ultrasound transducer is placed in a paramedian sagittal orientation and
moved laterally until transverse processes are visible. Usually an in-plane approach
is used with local anesthetic injected below the erector spinae muscle to effectively
“lift” this muscle off the transverse processes below [88].
This block can be used for a wide variety of surgical procedures in the anterior,
posterior, and lateral thoracic areas. Complications are rare, but include pleural punc-
ture, pneumothorax, and other complications associated with regional techniques
[88].
ESP blocks are not well studied in cardiac surgery, but have been shown to
decrease opioid consumption, pain scores, duration of time in the ICU, and time
to extubation [89–91]. One prospective study of 50 patients demonstrated that ESP
blocks were comparable to TEA with regard to postoperative pain scores, incentive
spirometry, and ventilator and ICU duration [92].
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352 E. R. Simon et al.
Pectointercostal Fascial Plane Block and Transverse Thoracic
Muscle Plane Block
The pectointercostal fascial plane block (PIFB) involves injecting local anesthetic
between the pectoralis major muscle and internal intercostal muscles to block the
anterior cutaneous branches of the intercostal nerves. The transverse thoracic muscle
plane (TTP) block is a deeper version of the PIFB with the injection of local anesthetic
occurring between the internal intercostal and transverse thoracic muscles. These
blocks target the T2-6 dermatomal distribution in a unilateral fashion meaning that
bilateral blocks would be required to provide sternotomy analgesia [93, 94].
The PIFB is usually performed with an in-plane needle approach with the ultra-
sound transducer in a parasagittal orientation 1–2 cm lateral to the sternum. The local
anesthetic is deposited between the pectoralis major and intercostal muscles. The TTP
utilizes the same approach, except the local anesthetic is deposited deeper between
the internal intercostal and transverse thoracic muscles. The injections usually occur
at the level of the fourth or fifth rib [94].
Both blocks can be helpful for midline chest surgeries including thymectomies,
sternotomies, and cardiac device implantation [93]. Complications are rare, but
include injury to the internal thoracic artery, pneumothorax, and pericardial puncture.
The PIFB is potentially safer than the TTP because it is a more superficial block.
Several studies have demonstrated that PIFBs decrease pain scores, opioid
consumption, time to extubation, ICU duration, and hospital length of stay after
cardiac surgery [95–99]. Several studies have also shown TTP blocks result in
decreased opioid consumption, pain scores, time to extubation, ICU duration,
and hospital length of stay after cardiac surgery [100–102]. A prospective study
comparing PIFB to TTP blocks showed that they have similar efficacy and that pain
scores and morphine consumption were similar for the two interventions in the first
24 h following cardiac surgery [103].
In general, studies on fascial plane blocks are limited in cardiac surgery but have
been shown to have promising results. Fascial plane blocks have advantages over
neuraxial blocks because they have a better safety profile, particularly in the setting
of anticoagulation, are associated with hemodynamic stability, and can be performed
under general anesthesia with most in a supine position. More randomized controlled
trials are needed to effectively compare the various fascial plane blocks as well as
continuous versus single shot blocks in both minimally invasive and open cardiac
surgeries.
7 Conclusion
The push for fast-track and ERAS protocols for the postoperative management of
the typical cardiac surgical patient has emphasized the need for aggressive pain
management. Similar to noncardiac surgery, effective perioperative pain control can
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Perioperative Pain Management of Patients Presenting for Cardiac Surgery 353
improve patient morbidity and mortality after cardiac surgery. Each member of the
care team can make a significant contribution towards this effort, from preopera-
tive education to prevention to assessment and treatment. In addition to standard
multimodal management using oral and intravenous medications, the recent devel-
opment of novel regional anesthesia techniques necessitates their inclusion in the
perioperative management of the cardiac surgical patient.
References
1. Zubrzycki M, Liebold A, Skrabal C, et al. Assessment and pathophysiology of pain in cardiac
surgery. J Pain Res. 2018;11:1599–611.
2. Doenst T, Essa Y, Jacoub K, et al. Cardiac surgery 2016 reviewed. Clin Res Cardiol.
2017;106(11):851–67.
3. Cogan J. Pain management after cardiac surgery. Semin Cardiothorac Vasc Anesth.
2010;14(3):201–4.
4. Bigeleisen PE, Goehner N. Novel approaches in pain management in cardiac surgery. Curr
Opin Anaesthesiol. 2015;28(1):89–94.
5. Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26(2):355–
67.
6. Markman PL, Rowland MA, Leong JY, et al. Skeletonized internal thoracic artery harvesting
reduces chest wall dysesthesia after coronary bypass surgery. J Thorac Cardiovasc Surg.
2010;139:674–9.
7. Reimer-Kent J. From theory to practice: preventing pain after cardiac surgery. Am J Crit Care.
2003;12(2):136–43.
8. Sommer M, de Rijke JM, van Kleef M, et al. The prevalence of postoperative pain in a sample
of 1490 surgical inpatients. Eur J Anaesthesiol. 2008;25(4):267–74.
9. Träger K, Fritzler D, Fischer G, et al. Treatment of post-cardiopulmonary bypass SIRS by
hemoadsorption: a case series. Int J Artif Organs. 2016;39(3):141–6.
10. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis
for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–45.
11. Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, von Segesser LK. Pain
location, distribution, and intensity after cardiac surgery. Chest. 2000;118(2):391–6.
12. Nelson F, Zimmerman L, Barnason S, Nieveen J, Schmaderer M. The relationship and influ-
ence of anxiety on postoperative pain in the coronary artery bypass graft patient. J Pain
Symptom Manage. 1998;15(2):102–9.
13. Greszta E, Siemińska MJ. [Relationship of preoperative anxiety-state and anxiety-trait in
patients qualified for coronary artery bypass graft surgery to the perception of postoperative
pain and other pain complaints]. Ann Acad Med Stetin. 2008;54(1):157–63. Polish.
14. Thibodeau MA, Welch PG, Katz J, Asmundson GJ. Pain-related anxiety influences pain
perception differently in men and women: a quantitative sensory test across thermal pain
modalities. Pain. 2013;154(3):419–26.
15. Tan EC, Lim Y, Teo YY, Goh R, Law HY, Sia AT. Ethnic differences in pain perception and
patient-controlled analgesia usage for postoperative pain. J Pain. 2008;9:849–55.
16. Stites M. Pain management observational pain scales in critically ill adults. Crit Care Nurse.
2013;33:68–79.
17. Linde S, Badger J, Roy N, et al. Re-evaluation of the critical care pain observation tool in
intubated adults after cardiac surgery. Am J Crit Care. 2013;22:491–7.
18. Cogan J, Ouimette M, Vargas-Schaffer G, et al. Patient attitudes and beliefs regarding pain
medication after cardiac surgery: barriers to adequate pain management. Pain Manag Nurs.
2014;15:574–9.
https://t.me/med1917
354 E. R. Simon et al.
19. Offner KA, Loop T. Pathophysiology and epidemiology of pain in thoracic surgery.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47(9):568–75.
20. Roncada G, Dendale P, Linsen L, Hendrikx M, Hansen D. Reduction in pulmonary function
after CABG surgery is related to postoperative inflammation and hypercortisolemia. Int J Clin
Exp Med. 2015;8(7):10938–46.
21. Milgrom LB, Brooks JA, Qi R. Pain levels experienced with activities after cardiac surgery.
Am J Crit Care. 2004;13(2):116–25.
22. Liu SS, Wu CL, Cl W. Effect of postoperative analgesia on major postoperative complications:
a systematic update of the evidence. Anesth Analg. 2007;104(3):689–702.
23. Schultz CH, Rivers EP, Feldkamp CS, et al. A characterization of hypothalamic-pituitary-
adrenal axis function during and after human cardiac arrest. Crit Care Med. 1993;21(9):1339–
47.
24. Swarm RA, Karanikolas M, Kalauokalani D. Pain treatment in the perioperative period. Curr
Probl Surg. 2001;38(11):835–920.
25. Jayakumar S, Borrelli M, Milan Z, Kunst G, Whitaker D. Optimising pain management
protocols following cardiac surgery: a protocol for a national quality improvement study. Int
J Surg Protoc. 2019;14:1–8.
26. Werner MU, Kongsgaard UEI. Defining persistent post-surgical pain: is an update required?
Br J Anaesth. 2014;113(1):1–4.
27. Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of
1-year incidence and intensity. Anesthesiology. 2006;105(4):794–800.
28. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention.
Lancet. 2006;367:1618–25.
29. White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F. Fast-track surgery study
group. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to
perioperative medical care. Anesth Analg. 2007;104(6):1380–96.
30. Graham GG, Scott KF. Mechanism of action of paracetamol. Am J Ther. 2005;12(1):46–55.
31. Mielke CH Jr. Comparative effects of aspirin and acetaminophen on hemostasis. Arch Intern
Med. 1981;141(3 Spec No):305–10.
32. Hoftiezer JW, O’Laughlin JC, Ivey KJ. Effects of 24 hours of aspirin, Bufferin, paracetamol
and placebo on normal human gastroduodenal mucosa. Gut J. 1982;23(8):692–7.
33. Jelacic S, Bollag L, Bowdle A, Rivat C, Cain KC, Richebe P. Intravenous acetaminophen as an
adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse
effects: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2016;30(4):997–1004.
34. Subramaniam B, Shankar P, Shaefi S, et al. Effect of intravenous acetaminophen vs placebo
combined with propofol or dexmedetomidine on postoperative delirium among older patients
following cardiac surgery: the DEXACETrandomized clinical trial. JAMA.2019;321(7):686–
96.
35. Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). In: StatPearls.
Treasure Island (FL): StatPearls Publishing; 2022.
36. Nussmeier NA, Whelton AA, Brown MT, et al. Complications of the COX-2 inhibitors
parecoxib and valdecoxib after cardiac surgery. N Engl J Med. 2005;352(11):1081–91.
37. Gislason GH, Jacobsen S, Rasmussen JN, et al. Risk of death or reinfarction associated with the
use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory
drugs after acute myocardial infarction. Circulation. 2006;113(25):2906–13.
38. US Food and Drug Administration. FDA Drug Safety C ommunication: FDA strengthens
warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart
attacks or strokes. 2015. Available at https://www.fda.gov/drugs/drugsafety/ucm451800.htm
39. Qazi SM, Sindby EJ, Nørgaard MA. Ibuprofen—a safe analgesic during cardiac surgery
recovery? a randomized controlled trial. J Cardiovasc Thorac Res. 2015;7(4):141–8.
40. Kulik A, Bykov K, Choudhry NK, Bateman BT. Non-steroidal anti-inflammatory drug admin-
istration after coronary artery bypass surgery: utilization persists despite the boxed warning.
Pharmacoepidemiol Drug Saf. 2015;24(6):647–53.
https://t.me/med1917
Perioperative Pain Management of Patients Presenting for Cardiac Surgery 355
41. Hayashida K, DeGoes S, Curry R, Eisenach JC. Gabapentin activates spinal noradren-
ergic activity in rats and humans and reduces hypersensitivity after surgery. Anesthesiology.
2007;106(3):557–62.
42. Chincholkar M. Analgesic mechanisms of gabapentinoids and effects in experimental pain
models: a narrative review. Br J Anaesth. 2018;120(6):1315–34.
43. VerretM, Lauzier F, Zarychanski R, et al. Perioperative use of Gabapentinoids for the manage-
ment of postoperative acute pain: a systematic review and meta-analysis [published correction
appears in Anesthesiology. 2020 Aug 21]. Anesthesiology 2020;133(2):265–79.
44. Menda F, Köner O, SayınM,Ergenoğlu M, Küçükaksu S, Aykaç B. Effects of single-
dose gabapentin on postoperative pain and morphine consumption after cardiac surgery. J
Cardiothorac Vasc Anesth. 2010;24(5):808–13.
45. Ziyaeifard M, Mehrabanian MJ, Faritus SZ, et al. Premedication with oral pregabalin for the
prevention of acute postsurgical pain in coronary artery bypass surgery. Anesth Pain Med.
2015;5(1):e24837.
46. Anwar S, Cooper J, Rahman J, Sharma C, Langford R. Prolonged perioperative use of
pregabalin and ketamine to prevent persistent pain after cardiac surgery. Anesthesiology.
2019;131(1):119–31.
47. Maitra S, Baidya DK, Bhattacharjee S, Som A. Gabapentina e pregabalina no período
perioperatório em cirurgia cardíaca: uma revisão sistemática e metanálise [Perioperative
gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis]. Rev
Bras Anestesiol. 2017;67(3):294–304.
48. Rosenbaum SB, Gupta V, Patel P, Palacios JL. Ketamine. In: StatPearls. Treasure Island (FL):
StatPearls Publishing; 2022.
49. Lahtinen P, Kokki H, Hakala T, Hynynen M. S(+)-ketamine as an analgesic adjunct reduces
opioid consumption after cardiac surgery. Anesth Analg. 2004;99(5):1295–301.
50. Nesher N, Ekstein MP, Paz Y,Marouani N, Chazan S, WeinbroumAA. Morphine with adjuvant
ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia. Chest.
2009;136(1):245–52.
51. Mazzeffi M, Johnson K, Paciullo C. Ketamine in adult cardiac surgery and the cardiac surgery
Intensive care unit: an evidence-based clinical review. Ann Card Anaesth. 2015;18(2):202–9.
52. Hudetz JA, Patterson KM, Iqbal Z, et al. Ketamine attenuates delirium after cardiac surgery
with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23(5):651–7.
53. Avidan MS, Maybrier HR, Abdallah AB, et al. Intraoperative ketamine for prevention of
postoperative delirium or pain after major surgery in older adults: an international, multi-
centre, double-blind, randomised clinical trial [published correction appears in Lancet.
2017;390(10091):230. Lancet. 2017;390(10091):267–75.
54. Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive
care. Anesth Essays Res. 2011;5(2):128–33.
55. Habibi V, Kiabi FH, Sharifi H. The effect of dexmedetomidine on the acute pain after
cardiothoracic surgeries: a systematic review. Braz J Cardiovasc Surg. 2018;33:404–17.
56. Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac
surgery. Circulation. 2013;127(15):1576–84.
57. Wang G, Niu J, Li Z, Lv H, Cai H. The efficacy and safety of dexmedetomidine in cardiac
surgery patients: a systematic review and meta-analysis. PLoS ONE. 2018;13(9):e0202620.
58. De Oliveira GS, Jr AMD, Benzon HT, McCarthy RJ. Perioperative single dose systemic
dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials.
Anesthesiology. 2011;115(3):575–88.
59. Myles PS, Corcoran T. Benefits and risks of dexamethasone in noncardiac surgery. Anesthe-
siology. 2021;135(5):895–903.
60. Turan A, Belley-Cote EP, Vincent J, et al. Methylprednisolone does not reduce persistent pain
after cardiac surgery. Anesthesiology. 2015;123(6):1404–10.
61. Dieleman JM, Nierich AP, Rosseel PM, et al. Intraoperative high-dose dexamethasone for
cardiac surgery: a randomized controlled trial. JAMA. 2012;308(17):1761–7.
62. Shin HJ, Na HS, Do SH. Magnesium and pain. Nutrients. 2020;12(8):2184.
https://t.me/med1917
356 E. R. Simon et al.
63. Steinlechner B, Dworschak M, Birkenberg B, et al. Magnesium moderately decreases
remifentanil dosage required for pain management after cardiac surgery. Br J Anaesth.
2006;96(4):444–9.
64. Ferasatkish R, Dabbagh A, Alavi M, et al. Effect of magnesium sulfate on extubation time and
acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand. 2008;52:1348–52.
65. Dunn LK, Durieux ME. Perioperative use of intravenous lidocaine. Anesthesiology.
2017;126(4):729–37.
66. Kranke P, Jokinen J, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion
for postoperative pain and recovery. Cochrane Database Syst Rev. 2015;7:CD009642.
67. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and
postoperative recovery after abdominal surgery. Br J Surg. 2008;95(11):1331–8.
68. Vigneault L, Turgeon AF, Côté D, et al. Perioperative intravenous lidocaine infusion for
postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth.
2011;58(1):22–37.
69. Insler SR, O’Connor M, Samonte AF, Bazaral MG. Lidocaine and the inhibition of postoper-
ative pain in coronary artery bypass patients. J Cardiothorac Vasc Anesth. 1995;9(5):541–6.
70. Wang D, Wu X, Li J, Xiao F, Liu X, Meng M. The effect of lidocaine on early postoperative
cognitive dysfunction after coronary artery bypass surgery. Anesth Analg. 2002;95(5):1134–
41.
71. Glenesk NL, Rahman S, Lopez PP. Anatomy, thorax, intercostal nerves. 2022.
72. Sertcakacilar G, Tire Y, Kelava M, et al. Regional anesthesia for thoracic surgery: a narrative
review of indications and clinical considerations. J Thorac Dis. 2022;14(12):5012–28.
73. Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without
cardiopulmonary bypass. Cochrane Database Syst Rev. 2019;3(3):CD006715.
74. Landoni G, Isella F, Greco M, Zangrillo A, Royse CF. Benefits and risks of epidural analgesia
in cardiac surgery. Br J Anaesth. 2015;115(1):25–32.
75. Ultrasound-Guided Thoracic Paravertebral Block. NYSORA. Available at https://www.
nysora.com/pain-management/ultrasound-guided-thoracic-paravertebral-block. Accessed 15
May 2024.
76. Sun L, Li Q, Wang Q, Ma F, Han W, Wang M. Bilateral thoracic paravertebral block combined
with general anesthesia vs. general anesthesia for patients undergoing off-pump coronary
artery bypass grafting: a feasibility study. BMC Anesthesiol. 2019;19(1):101.
77. Naganuma M, Tokita T, Sato Y, et al. Efficacy of preoperative bilateral thoracic paraver-
tebral block in cardiac surgery requiring full heparinization: a propensity-matched study. J
Cardiothorac Vasc Anesth. 2022;36(2):477–82.
78. Cantó M, Sánchez MJ, Casas MA, Bataller ML. Bilateral paravertebral blockade for
conventional cardiac surgery. Anaesthesia. 2003;58(4):365–70.
79. 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.
80. Olivier JF, Bracco D, Nguyen P, Le N, Noiseux N, Hemmerling T. A novel approach for pain
management in cardiac surgery via median sternotomy: bilateral single-shot paravertebral
blocks. Heart Surg Forum. 2007;10(5):E357–62.
81. Jiang T, Ting A, Leclerc M, Calkins K, Huang J. Regional anesthesia in cardiac surgery: a
review of the literature. Cureus. 2021;13(10):e18808.
82. Battista C, Krishnan S. Pectoralis Nerve Block. In: StatPearls. Treasure Island (FL): StatPearls;
2023.
83. Kumar KN, Kalyane RN, Singh NG, et al. Efficacy of bilateral pectoralis nerve block for
ultrafast tracking and postoperative pain management in cardiac surgery. Ann Card Anaesth.
2018;21(3):333–8.
84. Southgate SJ, Herbst MK. Ultrasound guided serratus anterior blocks. In: StatPearls. Treasure
Island (FL): StatPearls Publishing; 2022.
85. Berthoud V, Ellouze O, Nguyen M, et al. Serratus anterior plane block for minimal invasive
heart surgery. BMC Anesthesiol. 2018;18(1):144.
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