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Neuraxial Anesthesia and Analgesia During Cardiothoracic Surgery: A Narrative Review

  • New and Emerging Therapies in Interventional Pain Medicine (J Hasoon, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to synthesize and examine the literature on the use of neuraxial anesthesia and analgesia during cardiothoracic surgery. As cardiothoracic procedures often require systemic anticoagulation, neuraxial techniques are quite often underutilized due to the theoretical risk of epidural hematoma. In this review, we seek to examine the literature to review the indications and contraindications and to explore if neuraxial anesthesia and analgesia has a role in cardiothoracic surgery.

Recent Findings

Neuraxial techniques have multiple advantages during cardiothoracic surgery including coronary vasodilation, decreased sympathetic surge, and a decreased cortisol level leading to overall reduction in stress response. Multiple studies have shown an improvement in pain scores, reduction in pulmonary complications, faster extubation times, with minimal complications when neuraxial techniques are utilized in cardiothoracic surgeries.

Summary

Given the numerous advantages and minimal complications of neuraxial techniques in cardiothoracic surgeries, we hope its utilization continues to increase. Moving forward, we hope additional studies continue to reaffirm the benefits of neuraxial anesthesia and analgesia for cardiothoracic surgeries to improve its utilization.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgements

The authors would like to thank Dr. Lisa Wofford (Chief of Anesthesiology at Ben Taub General Hospital) and Dr. Lee Chang (Anesthesiology Program Director at Baylor College of Medicine) for the continued support.

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Authors and Affiliations

  1. Baylor College of Medicine, Houston, TX, 77030, USA

    Kevin Chen, Kyle Gashler, Tommy Li & Anvinh Nguyen

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Contributions

K.C. reviewed neuraxial anesthesia for cardiac surgery and contributed to that section of the manuscript. K.G. reviewed neuraxial analgesia for cardiac surgery and contributed to that section of the manuscript. T.L. contributed to the introduction of the manuscript. A.N. contributed to the abstract, conclusion, and is the corresponding author for the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Anvinh Nguyen.

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The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Chen, K., Gashler, K., Li, T. et al. Neuraxial Anesthesia and Analgesia During Cardiothoracic Surgery: A Narrative Review. Curr Pain Headache Rep 28, 315–319 (2024). https://doi.org/10.1007/s11916-024-01235-5

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