Ultrasound Guided Regional Anesthesia in Thoracic Surgery

Perioperative analgesia plays an important role in thoracic surgery, regarding not only patient satisfaction, but also in preventing postoperative complications such as pneumonia. Ultrasound-guided thoracic wall blocks close the gap between opiate based and neuraxial pain management concepts. The following article explores the different ultrasound-guided approaches to anesthetize the thoracic wall, ranging from the ventral blocks such as parasternal or PECS I/II, followed by the lateral blocks (i.e. serratus anterior), up to the dorsal approaches including the paravertebral, erector spinae plane, and retrolaminar block. In summary, the anterolateral blocks are supplementary blocks in an opiate sparing, multimodal anaesthesia concept, whereas the dorsal procedures, as they include visceral anaesthesia, are an alternative to neuraxial anaesthesia, as they have a comparable analgetic potency. For minimally invasive thoracic surgery, where due to risk-benefit considerations epidural anaesthesia is omitted, thoracic wall blocks can be utilized in a single shot or a continuous, catheter-based approach.