Implementation of Bilateral Rectus Sheath Blocks in Conjunction With Transversus Thoracis Plane and Pectointercostal Fascial Blocks for Immediate Postoperative Analgesia After Cardiac Surgery

Lauren Everett, TomMario A Davis, Seema P Deshpande, Samhati Mondal, Lauren Everett, TomMario A Davis, Seema P Deshpande, Samhati Mondal

Abstract

Pain continues to be a well-known complication of cardiac surgery in the postoperative period and intravenous opioid analgesia has traditionally been employed to manage cardiac surgical pain. However, both components have contributed to a multitude of undesirable adverse effects which can further exacerbate delays in recovery. Often overlooked in the analgesic plan, chest tube pain contributes significantly to the overall postoperative pain from cardiac surgery. Novel regional anesthetic blocks have shown great promise as analgesic adjuncts for cardiothoracic anesthesia but preliminary investigations focus primarily on management of sternotomy pain. Reduction of chest tube pain should be considered while implementing regional blocks to control surgical pain. This study presents a case where the rectus sheath block minimized chest tube pain after aortic valve replacement in conjunction with intercostal nerve blocks and a multimodal analgesic plan.

Keywords: adult cardiac surgery; chest tube; multimodality pain management; postoperative pain relief; rectus sheath block; ultrasound-guided regional anesthesia.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Everett et al.

Figures

Figure 1. Rectus sheath block
Figure 1. Rectus sheath block
Arrow pointing to needle tip injecting local anesthetic into posterior sheath of rectus abdominus between the rectus abdominus muscle (superficial) and peritoneal cavity (deep).
Figure 2. Transversus thoracis muscle plane block
Figure 2. Transversus thoracis muscle plane block
Arrow pointing to needle tip injecting local anesthetic at the fourth and fifth intercostal spaces into the fascial plane between the internal intercostal (superficial) and transversus thoracis (deep) muscles.
Figure 3. Pectointercostal fascial block
Figure 3. Pectointercostal fascial block
Arrow pointing to needle tip injecting local anesthetic between the pectoralis major (superficial) and intercostal (deep) muscles.

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Source: PubMed

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