Our Summary

This research paper reviews the effectiveness of non-spinal regional nerve blocks for pain relief after sternotomy in cardiac surgery. Sternotomy is a surgical procedure that involves splitting the chest open to gain access to the heart and lungs. Managing post-surgery pain well is important to prevent negative effects on heart function and to avoid lung complications.

In the fast-paced medical field, using effective pain relief techniques after surgery can help patients recover quicker, leaving the intensive care unit sooner. With more expertise in ultrasound-guided blocks, there’s a growing interest in using bilateral nerve blocks for pain relief after sternotomy.

The paper found 17 articles directly related to the use of non-spinal regional nerve blocks in all study designs. But due to the limited number of studies and their differences, it wasn’t possible to carry out a systematic review, or a meta-analysis (a statistical analysis that combines the results of multiple studies).

The paper concludes that it’s not possible to say whether these blocks are better than each other due to the lack of literature. However, most reviewed techniques were found to be as effective, or even better than, traditional techniques.

FAQs

  1. What is the significance of managing acute post-operative pain following sternotomy in cardiac surgery?
  2. What role does ultrasound-guided blocks play in managing pain after sternotomy?
  3. Are non-neuraxial regional nerve blocks superior to conventional techniques for pain relief following sternotomy in cardiac surgery?

Doctor’s Tip

A helpful tip a doctor might give a patient about sternotomy is to follow their post-operative pain management plan closely. Adequately managing pain following sternotomy is crucial for a successful recovery, so be sure to take any prescribed medications as directed and communicate any concerns or changes in pain levels to your healthcare team. Additionally, following any recommended physical therapy or exercises can help improve recovery and reduce pain.

Suitable For

Patients undergoing cardiac surgery with sternotomy are typically recommended for non-neuraxial regional nerve blocks for post-operative pain relief. These patients may include those undergoing coronary artery bypass grafting, valve replacement, or other cardiac procedures requiring sternotomy. The use of regional nerve blocks following sternotomy can help to improve post-operative pain management, facilitate early extubation, mobilization, and discharge from the intensive care unit.

Timeline

Before sternotomy:

  • Patient undergoes pre-operative evaluation and preparation for surgery
  • Patient is informed about the procedure and risks involved
  • Patient may undergo pre-operative nerve blocks or other pain management techniques
  • Patient is taken to the operating room and undergoes sternotomy procedure

After sternotomy:

  • Patient wakes up in the recovery room or intensive care unit
  • Patient may experience acute post-operative pain
  • Patient is monitored closely for any complications
  • Patient is provided with pain medication and other forms of pain management
  • Patient is gradually weaned off of mechanical ventilation
  • Patient is encouraged to start moving and mobilizing as soon as possible
  • Patient is discharged from the hospital once stable and able to manage pain effectively

Overall, the timeline for a patient before and after sternotomy involves preparation, surgery, post-operative pain management, monitoring, and recovery.

What to Ask Your Doctor

  1. What are the potential risks and benefits of having a sternotomy for my cardiac surgery?
  2. What kind of pain management options are available for me following sternotomy?
  3. Are there any non-narcotic alternatives for pain relief after sternotomy?
  4. How long can I expect to experience pain after having a sternotomy?
  5. Are there any specific activities or movements I should avoid to prevent worsening pain after sternotomy?
  6. How can I best prepare for managing pain during my recovery from sternotomy?
  7. Are there any specific complications I should watch out for related to my sternotomy incision?
  8. How frequently should I follow up with you or another healthcare provider to monitor my recovery from sternotomy?
  9. Are there any specific signs or symptoms that I should report to you immediately following sternotomy?

Reference

Authors: Kar P, Ramachandran G. Journal: Ann Card Anaesth. 2020 Apr-Jun;23(2):200-208. doi: 10.4103/aca.ACA_241_18. PMID: 32275036