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Chest Wall Nerve Blocks for Cardiothoracic, Breast Surgery, and Rib-Related Pain

  • Acute Pain Medicine (R Urman, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Perioperative analgesia in patients undergoing chest wall procedures such as cardiothoracic and breast surgeries or analgesia for rib fracture trauma can be challenging due to several factors: the procedures are more invasive, the chest wall innervation is complex, and the patient population may have multiple comorbidities increasing their susceptibility to the well-defined pain and opioid-related side effects. These procedures also carry a higher risk of persistent pain after surgery and chronic opioid use making the analgesia goals even more important.

Recent Findings

With advances in ultrasonography and clinical research, regional anesthesia techniques have been improving and newer ones with more applications have emerged over the last decade. Currently in cardiothoracic procedures, para-neuraxial and chest wall blocks have been utilized with success to supplement or substitute systemic analgesia, traditionally relying on opioids or thoracic epidural analgesia. In breast surgeries, paravertebral blocks, serratus anterior plane blocks, and pectoral nerve blocks have been shown to be effective in providing pain control, while minimizing opioid use and related side effects. Rib fracture regional analgesia options have also expanded and continue to improve. 

Summary

Advances in regional anesthesia have tremendously improved multimodal analgesia and contributed to enhanced recovery after surgery protocols. This review provides the latest summary on the use and efficacy of chest wall blocks in cardiothoracic and breast surgery, as well as rib fracture-related pain and persistent postsurgical pain.

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Acknowledgements

We would like to thank Eli Orton for helping with the anatomy images.

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  1. Division of Regional Anesthesiology, Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, 10032, USA

    Richa Sharma, Aaron Louie, Carolyn P. Thai & Anis Dizdarevic

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Sharma, R., Louie, A., Thai, C.P. et al. Chest Wall Nerve Blocks for Cardiothoracic, Breast Surgery, and Rib-Related Pain. Curr Pain Headache Rep 26, 43–56 (2022). https://doi.org/10.1007/s11916-022-01001-5

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