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• W3213651996 abstract "Central MessageFluoroscopic confirmation of proper thoracic epidural placement may augment the safety and utility of this regional anesthetic technique in congenital cardiac surgery.See Article page XXX. Fluoroscopic confirmation of proper thoracic epidural placement may augment the safety and utility of this regional anesthetic technique in congenital cardiac surgery. See Article page XXX. In the current issue of the Journal, Schmehil and colleagues1Schmehil C. Lee K.-J. Casella S. Millan D. Thoracic epidural anesthesia in congenital heart surgery.J Thorac Cardiovasc Surg Tech. October 23, 2021; ([Epub ahead of print])Google Scholar report the results of a single-center retrospective review of fluoroscopically guided thoracic epidural (fTEA) analgesia in patients undergoing congenital cardiac surgery. The primary aim was to demonstrate successful thoracic epidural catheter placement using fluoroscopy. The authors postulate that incorporating fTEA confirmed with an epidurogram after placement improves safety and efficacy. This is supported by the fact that 119 of 120 patients underwent successful placement without complications. Additional outcome measures reported included duration of intubation and hospital length of stay, but no comparative data or pain related measures of efficacy were included. Neuraxial and regional anesthesia have been identified as key components of Enhanced Recovery After Surgery (ERAS) protocols, including following cardiac surgery. These adjuvants are purported to reduce opioid requirements, leading to improved outcomes and resource use. Epidural and paravertebral blocks have been most frequently studied; however, emerging non-neuraxial truncal regional anesthetic techniques, including pectointercostal fascial blocks and erector spinae plane blocks, may offer similar analgesic benefits with reduced complication potential, especially in the setting of systemic anticoagulation.2Roy N. Brown M.L. Parra M.F. Sleeper L.A. Alrayashi W. Nasr V.G. et al.Bilateral erector spinae blocks decrease perioperative opioid use after pediatric cardiac surgery.J Cardiothorac Vasc Anesth. 2021; 35: 2082-2087Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 3Kaushal B. Chauhan S. Magoon R. Krishna N.S. Saini K. Bhoi D. et al.Efficacy of bilateral erector spinae plane block in management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy.J Cardiothorac Vasc Anesth. 2020; 34: 981-986Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 4Voulgarelis S. Halenda G.M. Tanem J.M. A novel use of liposomal bupivacaine in erector spinae plane block for pediatric congenital cardiac surgery.Case Rep Anesthesiol. 2021; 2021: 5521136PubMed Google Scholar, 5Holland E.L. Bosenberg A.T. Early experience with erector spinae plane blocks in children.Paediatr Anaesth. 2020; 30: 96-107Crossref PubMed Scopus (20) Google Scholar, 6Sahajanandan R. Varsha A.V. Kumar D.S. Kuppusamy B. Karuppiah S. Shukla V. et al.Efficacy of paravertebral block in “Fast-tracking” pediatric cardiac surgery—experiences from a tertiary care center.Ann Card Anaesth. 2021; 24: 24-29Crossref PubMed Scopus (1) Google Scholar This reduced risk profile underscores the need to demonstrate a benefit to patients rather than merely reporting the absence of adverse of events. To truly evaluate the efficacy of fTEA in this setting, comparative studies incorporating pain-associated outcome measures are required. It is noteworthy that analyses of regional versus general anesthesia in adults and children have yielded conflicting data, with many newer studies failing to demonstrate an outcome benefit.7McCann M.E. de Graaff J.C. Dorris L. Disma N. Withington D. Bell G. et al.Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial.Lancet. 2019; 393: 664-677Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar,8Neuman M.D. Feng R. Carson J.L. Gaskins L.J. Dillane D. Sessler D.I. et al.Spinal anesthesia or general anesthesia for hip surgery in older adults.N Engl J Med. 2021; 385 ([Epub ahead of print]): 2025-2035https://doi.org/10.1056/NEJMoa2113514Crossref PubMed Scopus (7) Google Scholar This highlights that ultimately the type of anesthetic technique employed may be less important than making sure that it is done well, as Schmehil and colleagues have done in this study. Thoracic epidural anesthesia in congenital heart surgeryJTCVS TechniquesPreviewThoracic epidural anesthesia (TEA) is widely applied in thoracic and abdominal surgeries, but its use in cardiac surgery remains controversial.1 Epidural anesthesia acts as a sympathetic blockade with varying effects on the cardiovascular system depending on the vertebral level of access.1,2 In addition to analgesia, other benefits of TEA may include early recovery of consciousness, shortened time to extubation, improved pulmonary function, hemodynamic stability, reduction of tachyarrhythmias, improved postoperative glucose control, and improved acute kidney function. Full-Text PDF Open Access" @default.
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• W3213651996 date "2021-11-01" @default.
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• W3213651996 title "Commentary: X-ray Vision, A Superpower Against Postoperative Pain?" @default.
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