Our Summary

This research paper discusses different methods of managing pain for children after heart surgery. Traditionally, opioids have been used to control pain, but the exact dosage that would provide the best pain relief without causing too many side effects has not been agreed upon. There is a growing trend of using a lower dose of opioids to speed up patient recovery and minimize opioid-related side effects, but this may not fully manage the stress response in all children.

The paper talks about the use of regional anesthesia techniques, which work by blocking pain signals. These techniques have been shown to reduce pain and the need for opioids in children for up to 24 hours after heart surgery. However, these techniques are not widely used due to concerns about the rare but serious risk of hematoma, which can lead to serious neurological problems.

The paper reviews techniques that involve blocking nerves outside the spine, performed either at the front or the back of the chest to target the nerves between the ribs. It discusses several ultrasound-guided techniques and summarizes methods that involve the surgeon directly blocking pain or infusing a local anesthetic at the end of the surgery.

The review concludes that more research is needed to understand the risks and benefits of these techniques in children undergoing heart surgery. Currently, the evidence is based on small studies and case reports.

FAQs

  1. What is the traditional method of managing pain for children after heart surgery?
  2. What are some of the concerns about using regional anesthesia techniques in pain management for children post-heart surgery?
  3. What are some alternative techniques discussed in the paper for managing pain post-heart surgery in children?

Doctor’s Tip

A helpful tip a doctor might tell a patient about sternotomy is to follow post-operative care instructions carefully to help with the healing process. This may include avoiding certain movements or activities that could strain the sternum, taking prescribed pain medication as directed, and attending follow-up appointments to monitor recovery progress. It’s important to communicate any concerns or changes in symptoms to your healthcare provider to ensure proper healing and recovery after sternotomy surgery.

Suitable For

Patients who are typically recommended sternotomy are those who require open-heart surgery, such as coronary artery bypass surgery, heart valve repair or replacement, or congenital heart defect repair. These procedures often require access to the heart through the chest cavity, which necessitates a sternotomy – a surgical incision through the breastbone to access the heart. Patients with severe heart conditions that cannot be treated with less invasive methods may also undergo sternotomy.

Timeline

Timeline before and after sternotomy:

Before sternotomy:

  • Patient undergoes pre-operative evaluation and preparation for surgery
  • Patient may receive pre-operative medications for anxiety and pain management
  • Patient is taken to the operating room and undergoes anesthesia induction
  • Surgeon makes an incision in the chest and performs sternotomy to access the heart
  • Surgery is performed to address the underlying heart condition

After sternotomy:

  • Patient is taken to the recovery room and monitored closely for vital signs and pain levels
  • Patient may be given medications for pain management, typically opioids
  • Patient is gradually weaned off of mechanical ventilation and extubated
  • Patient begins physical therapy and rehabilitation to promote recovery
  • Patient is discharged from the hospital and continues follow-up care with healthcare providers

Overall, the timeline for a patient before and after sternotomy involves thorough preparation for surgery, anesthesia induction, surgical intervention, post-operative pain management, monitoring, and rehabilitation to optimize recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sternotomy may include:

  1. What is a sternotomy and why is it necessary for my heart surgery?
  2. What are the potential risks and complications associated with a sternotomy?
  3. How long is the recovery period after a sternotomy?
  4. What pain management options will be available to me after the surgery?
  5. Are there alternative pain management techniques, such as regional anesthesia, that could be used instead of or in addition to opioids?
  6. What are the potential benefits and risks of using regional anesthesia techniques for pain management after heart surgery?
  7. How will the choice of pain management technique affect my recovery and overall outcome?
  8. Can you provide more information about the specific regional anesthesia techniques that may be used in my case?
  9. What are the potential side effects or complications of regional anesthesia techniques?
  10. Is there ongoing research or clinical trials related to pain management techniques for children undergoing heart surgery?

Reference

Authors: Raj N. Journal: Paediatr Anaesth. 2019 May;29(5):519-529. doi: 10.1111/pan.13626. PMID: 30861264