Thoracic Wall Fascial Plane Blocks For Pediatric Cardiac Surgery With Sternotomy

Abstract

Introduction: In paediatric patients undergoing sternotomy for cardiac surgery, inadequate pain management has been demonstrated to result in cardiopulmonary complications, the development of chronic pain, and prolonged stress responses. Opioids, which are frequently utilised for the purpose of analgesia in these patients, have been observed to induce dose-dependent adverse effects that have the potential to influence postoperative recovery. Methods: The increased utilisation of ultrasound in recent years has led to the integration of regional anaesthesia into multimodal analgesic approaches and its incorporation into Enhanced Recovery After Surgery (ERAS) protocols following cardiac surgery. Fascial plane blocks target intercostal nerves and ventral branches at multiple levels. Moreover, as they do not cause damage to the neuroaxial and paravertebral spaces during the procedure, they are a suitable option for postoperative analgesia in patients requiring full heparinisation for cardiopulmonary bypass. Conclusion: This review synthesises the extant literature on thoracic fascial plane blocks for paediatric patients undergoing cardiac surgery via median sternotomy, with the objective of providing a practical guide for clinicians.

Keywords

• pediatric cardiac surgery
• fascial plane blocks
• postoperative analgesia

Sternotomi İle Uygulanan Pediyatrik Kalp Cerrahisinde Torasik Duvar Fasyal Plan Blokları

Öz

Giriş: Kalp cerrahisi için sternotomi uygulanan pediatrik hastalarda yetersiz ağrı yönetiminin kardiyopulmoner komplikasyonlara, kronik ağrı gelişimine ve uzamış stres yanıtına yol açtığı gösterilmiştir. Bu hastalarda analjezi amacıyla sıklıkla kullanılan opioidlerin, postoperatif iyileşmeyi etkileme potansiyeline sahip doza bağlı yan etkilere neden olduğu gözlenmiştir. Yöntemler: Son yıllarda ultrasonun artan kullanımı, bölgesel anestezinin multimodal analjezik yaklaşımlara entegre edilmesine ve kalp cerrahisi sonrası Geliştirilmiş Ameliyat Sonrası İyileşme (ERAS) protokollerine dahil edilmesine yol açmıştır. Fasyal plan blokları, interkostal sinirleri ve ventral dalları birden çok seviyede bloke etmektedir. Ayrıca işlem sırasında nöraksiyel ve paravertebral boşluklarda hasar oluşturmadıkları için, kardiyopulmoner bypass için tam heparinizasyon gerektiren hastalarda postoperatif analjezi için uygun bir seçenektir. Sonuç: Bu derleme, median sternotomi yoluyla kalp cerrahisi geçiren pediatrik hastalarda torasik fasyal plan blokları ile ilgili mevcut literatürü sentezleyerek, klinisyenlere pratik bir rehber sağlamayı amaçlamaktadır.

Anahtar Kelimeler

• pediyarik kalp cerrahisi
• fasyal plane blokları
• postoperatif analjezi

Kaynakça

1. Mueller XM, Tinguely F, Tevaeari HT, Revelly JP, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118(2):391-6. [Crossref]
2. 2.Lauridsen MH, Kristensen AD, Hjortdal VE, Jensen S, Nikolajsen L. Chronic pain in children after cardiac surgery via sternotomy. Cardiol Young. 2014;24(5):893-9. [Crossref]
3. 3.Meier S, Borzel J, Hellner N, Catena D, Beck CE, Schindler E, et al. Enhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery: Status Quo of Implementation in Europe. J Cardiothorac Vasc Anesth. 2025;39(1):177-86. [Crossref]
4. 4.Pollak U, Serraf A. Pediatric Cardiac Surgery and Pain Management: After 40 Years in the Desert, Have We Reached the Promised Land? World J Pediatr Congenit Heart Surg. 2018;9(3):315-25. [Crossref]
5. 5.Wolf AR. Effects of regional analgesia on stress responses to pediatric surgery. Paediatr Anaesth. 2012;22(1):19-24. [Crossref]
6. 6.Guimarães-Pereira L, Reis P, Abelha F, Azevedo LF, Castro-Lopes JM. Persistent postoperative pain after cardiac surgery: a systematic review with metaanalysis regarding incidence and pain intensity. Pain. 2017;158(10):1869-85. [Crossref]
7. 7.Monahan A, Guay J, Hajduk J, Suresh S. Regional analgesia added to general anesthesia compared with general anesthesia plus systemic analgesia for cardiac surgery in children: a systematic review and meta-analysis of randomized clinical trials. Anesth Analg. 2019;128(1):130-6. [Crossref]
8. 8.Raj N. Regional anesthesia for sternotomy and bypass-beyond the epidural. Paediatr Anaesth. 2019;29(5):519-29. [Crossref] 9.Murphy T, Sale SM, Barlatay FG, Armstrong C, Pa