Regional anesthesia in coronary artery bypass grafting: a narrative review
- Authors: Koriachkin V.A.1, Dzhopua M.A.2, Ezugbaia B.S.3, Avetisian V.A.3, Zabolotskiy D.V.1, Evgrafov V.A.1
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Affiliations:
- Saint Petersburg State Pediatric Medical University
- Lapino Clinical Hospital
- Ilyinskaya Hospital
- Issue: Vol 17, No 3 (2023)
- Pages: 161-175
- Section: Reviews
- URL: https://journals.rcsi.science/1993-6508/article/view/249890
- DOI: https://doi.org/10.17816/RA568908
- ID: 249890
Cite item
Abstract
Coronary artery bypass grafting (CABG) is one of the most frequently performed procedures in modern cardiac surgery because it is indicated in most patients with coronary artery disease. Currently, there are no standard methods for regional anesthesia in cardiac surgery. The purpose of this review was to describe the available techniques for regional anesthesia in post-CABG. Studies published in the databases PubMed, The Cochrane Library, Google Scholar, Russian science citation index were included. Techniques reported in the literature were local blockade of the postoperative wound with local anesthetics in the anteromedial chest wall (parasternal-intercostal plane blocks), anterolateral chest wall (interpectoral plane blocks, serratus anterior plane block), and posterolateral chest wall (erector spinae plane block, thoracic paravertebral block, retrolaminar block, rhomboid intercostal block). Numerous studies demonstrate that the use of regional anesthesia as a component of multimodal anesthesia after coronary artery bypass grafting significantly improves pain relief. Blockade of the peripheral nerves of the chest wall under ultrasound guidance can be considered not only as an alternative to epidural anesthesia when not indicated or not feasible. It also contributes to early tracheal extubation, reduced duration of mechanical ventilation, adequate pain control, and a decrease in the need for narcotic analgesics, reduced postoperative nausea and vomiting, and reduced length of stay in the intensive care unit. Further research is needed to determine the optimal technique for performing interfascial blockades of the chest wall post-CABG, which would require data on the effectiveness, safety, and dosing regimen for each specific blockade.
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##article.viewOnOriginalSite##About the authors
Viktor A. Koriachkin
Saint Petersburg State Pediatric Medical University
Author for correspondence.
Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578
MD, Dr. Sci. (Med.), Professor
Russian Federation, St. PetersburgMaksim A. Dzhopua
Lapino Clinical Hospital
Email: Dzhopua.M.A@yandex.ru
ORCID iD: 0000-0002-9950-2814
SPIN-code: 3945-6170
anesthesiologist-resuscitator
Russian Federation, LapinoBeka S. Ezugbaia
Ilyinskaya Hospital
Email: ezugbaia.b.s@gmail.com
ORCID iD: 0000-0002-0271-4643
SPIN-code: 1713-7653
MD, Cand. Sci. (Med.), anesthesiologist-resuscitator
Russian Federation, KrasnogorskVaagn A. Avetisian
Ilyinskaya Hospital
Email: vaagnavetisian@gmail.com
ORCID iD: 0000-0001-6555-7369
SPIN-code: 4943-9611
anesthesiologist-resuscitator
Russian Federation, KrasnogorskDmitriy V. Zabolotskiy
Saint Petersburg State Pediatric Medical University
Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571
MD, Dr. Sci. (Med.), Professor
Russian Federation, St. PetersburgVladimir A. Evgrafov
Saint Petersburg State Pediatric Medical University
Email: evgrafov-spb@mail.ru
ORCID iD: 0000-0001-6545-2065
SPIN-code: 6322-3961
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, St. PetersburgReferences
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