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Acute Pain Management Protocol for Cardiac Procedures

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First Aid Perioperative Ultrasound


Regional anesthesia for cardiac surgery has fostered more interest with the implementation of enhanced recovery after surgery (ERAS) protocols and “fast-track” programs in the last decade (Grant et al. Anesth Analg. 131:1852-61, 2020; Cheng. Can J Anaesth. 52:12–7, 2005). Neuraxial, paraneuraxial, fascial plane, and directly targeted nerve blocks have all been described in the literature with varying efficacy and safety profiles. Currently, for both median sternotomy and thoracotomy approaches in open cardiac procedures, fascial plane nerve blocks are largely preferred due to their safety profile in the setting of heparinization, ease of performance, as well as their efficacy in randomized controlled trials (RCT) (Warfield et al. Curr Opin Anaesthesiol 33:692–7, 2020; Adhikary et al. J Cardiothorac Vasc Anesth. 33:1063-7, 2019).

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American Society of Regional Anesthesia and Pain Medicine


Body Mass Index


Coronary Artery Bypass Grafting


Enhanced Recovery After Surgery


Erector Spinae Plane


Intercostal Nerve Block


Intensive Care Unit


Internal Intercostal Muscle


Internal Mammary Artery


Local Anesthetic Systemic Toxicity


Pectointercostal Fascia Block


Post-Thoracotomy Pain Syndrome


Paravertebral Block


Randomized Controlled Trial


Serratus Anterior Plane


Transversus Thoracis Muscle


Transversus Thoracis Plane


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Correspondence to Dennis J. Warfield Jr. .

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Walker, J., Bose, R., Jordan, A., Warfield, D.J. (2023). Acute Pain Management Protocol for Cardiac Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham.

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