Pro: Regional Anesthesia for Cardiac Surgery with Sternotomy

WITH THE growing prevalence of cardiovascular disease worldwide, more than 2 million patients undergo median sternotomy for cardiac surgery annually. 1 van Gulik L Janssen LI Ahlers SJ et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011; 40: 1309-1313 PubMed Google Scholar The incidence of severe acute postoperative pain after sternotomy is as high as 49%, and appropriate management of this pain has important implications for short- and long-term recovery. 2 Guimaraes-Pereira L Farinha F Azevedo L et al. Persistent postoperative pain after cardiac surgery: Incidence, characterization, associated factors and its impact in quality of life. Eur J Pain. 2016; 20: 1433-1442 Crossref PubMed Scopus (39) Google Scholar Inadequate postsurgical pain control after sternotomy in cardiac surgery has profound negative consequences on pulmonary function, hemodynamics, myocardial oxygen demand, postoperative delirium, and intensive care unit (ICU) and hospital lengths of stay. 3 Beloeil H Sulpice L. Peri-operative pain and its consequences. J Visc Surg. 2016; 153: S15-S18 Crossref PubMed Scopus (25) Google Scholar Severe pain also has been shown to harm long-term outcomes such as quality of life, 4 Lahtinen P Kokki H Hynynen M. Pain after cardiac surgery - a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006; 105: 794-800 Crossref PubMed Scopus (204) Google Scholar ,5 Mueller XM Tinguely F Tevaearai HT et al. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000; 118: 391-396 Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar and is associated with the development of persistent poststernotomy pain with an incidence as high as 35% at 1-year follow-up. 1 van Gulik L Janssen LI Ahlers SJ et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011; 40: 1309-1313 PubMed Google Scholar ,6 King KM Parry M Southern D et al. Women's Recovery from Sternotomy-Extension (WREST-E) study: Examining long-term pain and discomfort following sternotomy and their predictors. Heart. 2008; 94: 493-497 Crossref PubMed Scopus (33) Google Scholar