Skip to main content
SpringerLink
Log in

Regional Anesthesia and Cardiovascular Disease

  • Chapter
  • First Online:
Book cover Essentials of Regional Anesthesia

  • 1964 Accesses

Abstract

Surgical stress can result in major adverse cardiac events, and this accounts for significant morbidity and mortality. More effective analgesia provided by regional block can allow for improved postoperative function which can improve recovery times and reduce potential complications. Furthermore, there are cardiovascular benefits with the use of different regional techniques for both cardiac and non-cardiac patients. In this chapter we review some of the different regional techniques for cardiac and non-cardiac patients including neuraxial block, epidural block, paravertebral and intercostal nerve blocks, as well as peripheral nerve block in patients with cardiac disease who are undergoing non-cardiac surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. N. Center for Health Statistics. Number of all-listed procedures for discharges from short-stay hospitals, by procedure category and age: United States, 2010; 2010.

    Google Scholar 

  2. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373(23):2258–69.

    Article  CAS  PubMed  Google Scholar 

  3. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  PubMed  Google Scholar 

  4. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.

    Article  CAS  PubMed  Google Scholar 

  5. Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK, Mythen MG. The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg. 2002;94(5):1072–8.

    Article  PubMed  Google Scholar 

  6. Veering BT. Cardiovascular and pulmonary effects of epidural anaesthesia. Minerva Anestesiol. 2003;69(5):433–7.

    PubMed  Google Scholar 

  7. Brull SJ, Greene NM. Zones of differential sensory block during extradural anaesthesia. Br J Anaesth. 1991;66(6):651–5.

    Article  CAS  PubMed  Google Scholar 

  8. Buggy DJ, Smith G. Epidural anaesthesia and analgesia: better outcome after major surgery?. Growing evidence suggests so. BMJ. 1999;319(7209):530–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003;238(5):663–73.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wang J, Guo W, Wu Q, Zhang R, Fang J. Impact of combination epidural and general anesthesia on the long-term survival of gastric cancer patients: a retrospective study. Med Sci Monit. 2016;22:2379–85.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kowalewski R, Seal D, Tang T, Prusinkiewicz C, Ha D. Neuraxial anesthesia for cardiac surgery: thoracic epidural and high spinal anesthesia - why is it different? HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(1):25–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Cheng DC, Karski J, Peniston C, Asokumar B, Raveendran G, Carroll J, Nierenberg H, Roger S, Mickle D, Tong J, Zelovitsky J, David T, Sandler A. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996;112(3):755–64.

    Article  CAS  PubMed  Google Scholar 

  13. Lee TWR, Grocott HP, Schwinn D, Jacobsohn E, Winnipeg High-Spinal Anesthesia Group. High spinal anesthesia for cardiac surgery: effects on beta-adrenergic receptor function, stress response, and hemodynamics. Anesthesiology. 2003;98(2):499–510.

    Article  CAS  PubMed  Google Scholar 

  14. Liu SS, Block BM, Wu CL. Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology. 2004;101(1):153–61.

    Article  CAS  PubMed  Google Scholar 

  15. Richardson L, Dunning J, Hunter S. Is intrathecal morphine of benefit to patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2008;8(1):117–22.

    Article  PubMed  Google Scholar 

  16. Fléron M-H, Weiskopf RB, Bertrand M, Mouren S, Eyraud D, Godet G, Riou B, Kieffer E, Coriat P. A comparison of intrathecal opioid and intravenous analgesia for the incidence of cardiovascular, respiratory, and renal complications after abdominal aortic surgery. Anesth. Analg. 2003;97(1):2–12.

    Article  PubMed  Google Scholar 

  17. Juelsgaard P, Sand NP, Felsby S, Dalsgaard J, Jakobsen KB, Brink O, Carlsson PS, Thygesen K. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol. 1998;15(6):656–63.

    Article  CAS  PubMed  Google Scholar 

  18. Rashid RH, Shah AA, Shakoor A, Noordin S. Hip fracture surgery: does type of anesthesia matter? Biomed Res Int. 2013;2013:1–5.

    Google Scholar 

  19. Latham P, Zarate E, White PF, Bossard R, Shi C, Morse LS, Douning LK, Chi L. Fast-track cardiac anesthesia: a comparison of remifentanil plus intrathecal morphine with sufentanil in a desflurane-based anesthetic. J Cardiothorac Vasc Anesth. 2000;14(6):645–51.

    Article  CAS  PubMed  Google Scholar 

  20. Bigeleisen PE, Goehner N. Novel approaches in pain management in cardiac surgery. Curr Opin Anaesthesiol. 2015;28(1):89–94.

    Article  PubMed  Google Scholar 

  21. V. Svircevic, M. M. Passier, A. P. Nierich, D. van Dijk, C. J. Kalkman, and G. J. van der Heijden, “Epidural analgesia for cardiac surgery,” in Cochrane Database of Systematic Reviews, no. 6, V. Svircevic, Ed. Chichester: Wiley, Ltd, 2013, p. CD006715.

    Google Scholar 

  22. Zhang S, Wu X, Guo H, Ma L. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur J Med Res. 2015;20(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Porizka M, Koudelkova K, Kopecky P, Porizkova H, Dohnalova A, Kunstyr J. High thoracic anesthesia offers no major benefit over general anesthesia in on-pump cardiac surgery patients: a retrospective study. Springerplus. 2016;5(1):799.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Caputo M, Alwair H, Rogers CA, Pike K, Cohen A, Monk C, Tomkins S, Ryder I, Moscariello C, Lucchetti V, Angelini GD. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery. Anesthesiology. 2011;114(2):380–90.

    Article  CAS  PubMed  Google Scholar 

  25. Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. In Guay J. (ed.) Cochrane database of systematic reviews. 1, Chichester: Wiley; 2016.

    Google Scholar 

  26. Bardia A, Sood A, Mahmood F, Orhurhu V, Mueller A, Montealegre-Gallegos M, Shnider MR, Ultee KHJ, Schermerhorn ML, Matyal R. Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg. 2016;151(12):1116.

    Article  PubMed  Google Scholar 

  27. Landoni G, Isella F, Greco M, Zangrillo A, Royse CF. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015;115(1):25–32.

    Article  CAS  PubMed  Google Scholar 

  28. Pöpping DM, Elia N, Van Aken HK, Marret E, Schug SA, Kranke P, Wenk M, Tramèr MR. Impact of epidural analgesia on mortality and morbidity after surgery. Ann Surg. 2014;259(6):1056–67.

    Article  PubMed  Google Scholar 

  29. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Poon JTC, Fan JKM, Lo OSH, Law WL. Enhanced recovery program in laparoscopic colectomy for cancer. Int J Color Dis. 2011;26(1):71–7.

    Article  Google Scholar 

  31. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5(5):342–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. de Groot JJ, Maessen JM, Slangen BF, Winkens B, Dirksen CD, van der Weijden T. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial. Implement Sci. 2015;10(1):106.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26(2):355–67.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418–26.

    Article  CAS  PubMed  Google Scholar 

  35. Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer EAM, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of randomized trials evaluating regional techniques for Postthoracotomy analgesia. Anesth Analg. 2008;107(3):1026–40.

    Article  CAS  PubMed  Google Scholar 

  36. Daly DJ, Myles PS. Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol. 2009;22(1):38–43.

    Article  PubMed  Google Scholar 

  37. Cantó M, Sánchez MJ, Casas MA, Bataller ML. Bilateral paravertebral blockade for conventional cardiac surgery. Anaesthesia. 2003;58(4):365–70.

    Article  PubMed  Google Scholar 

  38. Neuburger PJ, Ngai JY, Chacon MM, Luria B, Manrique-Espinel AM, Kline RP, Grossi EA, Loulmet DF. A prospective randomized study of paravertebral blockade in patients undergoing robotic mitral valve repair. J Cardiothorac Vasc Anesth. 2015;29(4):930–6.

    Article  PubMed  Google Scholar 

  39. Dhole S, Mehta Y, Saxena H, Juneja R, Trehan N. Comparison of continuous thoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2001;15(3):288–92.

    Article  CAS  PubMed  Google Scholar 

  40. Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659–65.

    Article  CAS  PubMed  Google Scholar 

  41. Gosselink R, Schrever K, Cops P, Witvrouwen H, De Leyn P, Troosters T, Lerut A, Deneffe G, Decramer M. Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med. 2000;28(3):679–83.

    Article  CAS  PubMed  Google Scholar 

  42. Rice DC, Cata JP, Mena GE, Rodriguez-Restrepo A, Correa AM, Mehran RJ. Posterior intercostal nerve block with liposomal bupivacaine: an alternative to thoracic epidural analgesia. Ann Thorac Surg. 2015;99(6):1953–60.

    Article  PubMed  Google Scholar 

  43. Khalil KG, Boutrous ML, Irani AD, Miller CC, Pawelek TR, Estrera AL, Safi HJ. Operative intercostal nerve blocks with long-acting bupivacaine liposome for pain control after thoracotomy. Ann Thorac Surg. 2015;100(6):2013–8.

    Article  PubMed  Google Scholar 

  44. Saby A, Swaminathan K, Pangarkar S, Tribuzio B. Alleviating thoracotomy pain with intercostal liposomal bupivacaine: a case report. PM&R. 2016;8(11):1119–22.

    Article  Google Scholar 

  45. Romero A, Garcia JEL, Joshi GP. The state of the art in preventing Postthoracotomy pain. Semin Thorac Cardiovasc Surg. 2013;25(2):116–24.

    Article  PubMed  Google Scholar 

  46. Piccioni F, Langer M, Fumagalli L, Haeusler E, Conti B, Previtali P. Thoracic paravertebral anaesthesia for awake video-assisted thoracoscopic surgery daily. Anaesthesia. 2010;65(12):1221–4.

    Article  CAS  PubMed  Google Scholar 

  47. Hall Burton DM, Boretsky KR. A comparison of paravertebral nerve block catheters and thoracic epidural catheters for postoperative analgesia following the Nuss procedure for pectus excavatum repair. Pediatr Anesth. 2014;24(5):516–20.

    Article  Google Scholar 

  48. Loftus PD, Elder CT, Russell KW, Spanos SP, Barnhart DC, Scaife ER, Skarda DE, Rollins MD, Meyers RL. Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children. J Pediatr Surg. 2016;51(1):149–53.

    Article  PubMed  Google Scholar 

  49. Kairaluoma PM, Bachmann MS, Rosenberg PH, Pere PJ. Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anesth Analg. 2006;103(3):703–8.

    Article  PubMed  Google Scholar 

  50. Karmakar MK, Samy W, Li JW, Lee A, Chan WC, Chen PP, Ho AM-H. Thoracic paravertebral block and its effects on chronic pain and health-related quality of life after modified radical mastectomy. Reg Anesth Pain Med. 2014;39(4):289–98.

    Article  PubMed  Google Scholar 

  51. Shah A, Rowlands M, Krishnan N, Patel A, Ott-Young A. Thoracic intercostal nerve blocks reduce opioid consumption and length of stay in patients undergoing implant-based breast reconstruction. Plast Reconstr Surg. 2015;136(5):584e–91e.

    Article  CAS  PubMed  Google Scholar 

  52. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105(4):660–4.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Murphy DF. Continuous intercostal nerve blockade for pain relief following cholecystectomy. Br J Anaesth. 1983;55(6):521–4.

    Article  CAS  PubMed  Google Scholar 

  54. Pourseidi B, Khorram-Manesh A. Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy. Surg Endosc. 2007;21(9):1557–9.

    Article  CAS  PubMed  Google Scholar 

  55. Chen J, Lin J, Chen X, Lin C. Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy. Clin Invest Med. 2015;38(6):E351–7.

    Article  CAS  PubMed  Google Scholar 

  56. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10(5):320–9.

    CAS  PubMed  Google Scholar 

  57. Galvagno SM, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, K. B. To, Fox AD, Alley DER, Ditillo M, Joseph BA, Robinson BRH, Haut ER. Pain management for blunt thoracic trauma: a joint practice management guideline from the eastern Association for the Surgery of trauma and trauma anesthesiology society. J Trauma Acute Care Surg. 2016;81(5):936–51.

    Article  PubMed  Google Scholar 

  58. Moore DC, Bridenbaugh LD. Intercostal nerve block in 4333 patients: indications, technique, and complications. Anesth Analg. 1962;41:1–11.

    Article  CAS  PubMed  Google Scholar 

  59. Abrahams M, Derby R, Horn J-L. Update on ultrasound for Truncal blocks. Reg Anesth Pain Med. 2016;41(2):275–88.

    Article  PubMed  Google Scholar 

  60. Hingorani AP, Ascher E, Gupta P, Alam S, Marks N, Schutzer RW, Multyala M, Multyala M, Shiferson A, Yorkovich W, Jacob T, Salles-Cunha S. Regional anesthesia: preferred technique for venodilatation in the creation of upper extremity arteriovenous fistulae. Vascular. 14(1):23–6.

    Google Scholar 

  61. Flaherty J, Horn J-L, Derby R. Regional anesthesia for vascular surgery. Anesthesiol Clin. 2014;32(3):639–59.

    Article  PubMed  Google Scholar 

  62. Brasileiro B, Imbelloni LE. Regional anesthesia in patients of aged 99 years in Clopidogrel use. Anesth Essays Res. 2017;11(1):257–9. https://doi.org/10.4103/0259-1162.186869.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA

    Veerandra Koyyalamudi MD, MBBS

  2. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Lien Tran MD

  3. Department of Anesthesiology, Louisiana State University, New Orleans, LA, USA

    Camellia D. Asgarian MD

  4. Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, USA

    Molly Kraus MD

  5. Anesthesiology, Mayo Clinic, Phoenix, AZ, USA

    Zacherie Conover MD

  6. Department of Anesthesiology, Mayo Clinic AZ, Phoenix, AZ, USA

    Jeremy Alvord MD

  7. Department of Anesthesiology, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA

    Elyse M. Cornett PhD

  8. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Alan David Kaye MD, PhD

Authors
  1. Veerandra Koyyalamudi MD, MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lien Tran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camellia D. Asgarian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Molly Kraus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zacherie Conover MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeremy Alvord MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elyse M. Cornett PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alan David Kaye MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    Potential benefits of regional block in cardiac patients undergoing surgery include all of the following except:

  1. (a)

    More effective analgesia

  2. (b)

    Improvements in postoperative function

  3. (c)

    Alleviation of surgical stress

  4. (d)

    Reduction in incidence of wound infection

  5. (e)

    Decreased length of stay

  1. 2.

    Which of the following is true about the autonomic nervous system?

  1. (a)

    Parasympathetic autonomic outflow originates from the thoracolumbar spinal cord segments.

  2. (b)

    Sympathetic autonomic outflow originates from the cranial nerves (3,7,9,10) and sacral spinal cord segments.

  3. (c)

    Parasympathetic outflow originates from the cranial nerves (3,7,9,10) and sacral spinal cord segments.

  4. (d)

    Sympathetic outflow originates from the thoracolumbar spinal cord segments.

  1. 3.

    Benefits of bilateral paravertebral block over an epidural block for patients undergoing thoracic surgery include:

    1. (a)

      Decrease in postoperative opioid requirements

    2. (b)

      Decrease in intraoperative blood loss

    3. (c)

      Reduced incidence of hypotension

    4. (d)

      Decreased hospital length of stay

    5. (e)

      Decreased incidence of post-thoracotomy pain syndrome

  2. 4.

    Enhanced recovery after surgery protocols have consistently shown which of the following improvements in patient care:

  1. (a)

    Reduction in complications

  2. (b)

    Earlier return of bowel function

  3. (c)

    Improved cardiopulmonary function

  4. (d)

    Decreased hospital length of stay

  1. 5.

    Analgesic options for patients undergoing cardiac or thoracic surgery include all of the following except:

  1. (a)

    Epidural block

  2. (b)

    Spinal block

  3. (c)

    Paravertebral block

  4. (d)

    Intercostal nerve block

  5. (e)

    Peripheral nerve block

Answers:

  1. 1.

    d

  2. 2.

    c, d

  3. 3.

    c

  4. 4.

    a, b, c

  5. 5.

    e

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Koyyalamudi, V. et al. (2018). Regional Anesthesia and Cardiovascular Disease. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74838-2_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation