Regional anesthesia for cardiothoracic surgery

Cardiac and thoracic surgery have been connected to high perioperative opioid use for a long time. With increasing knowledge of regional anesthesia in the thoracic region, thoracic nerve blocks have become supplemental methods of analgesia. As part of multimodal analgesia, they are important factors of enhanced recovery after surgery and contribute to a diminished opioid use. Myofascial nerve blocks are more superficial than the classic thoracic epidural anesthesia or paravertebral block and are therefore safer for use in anticoagulated patients. In this article, we present a number of thoracic blocks; the paraneuraxial paravertebral block; the myofascial plane blocks which are the retrolaminar block, the erector spinae plane block, the serratus anterior plane block, the pectoral nerves I and II block, the transversus thoracis plane block and the parasternal intercostal nerve block; the perineural intercostal nerve block and also local anesthetic infusion by a wound catheter. We conclude with local experience from a cardiac and thoracic surgical center.