Abstract：
OBJECTIVE: 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.
RESULTS: 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. 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.
RESULTS: 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. 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.
摘要：
目的：胸壁手术患者的围手术期镇痛，如心胸和乳房手术或肋骨骨折创伤的镇痛可能是具有挑战性的，胸壁神经支配很复杂，患者群体可能有多种合并症，增加了他们对明确定义的疼痛和阿片类药物相关副作用的易感性。这些程序还具有较高的手术后持续性疼痛的风险，并且长期使用阿片类药物使镇痛目标更加重要。
结果：随着超声和临床研究的进展，在过去的十年中，区域麻醉技术一直在改进，并且出现了更多应用的新技术。目前在心胸手术中，已经成功地利用了神经轴旁阻滞和胸壁阻滞来补充或替代全身镇痛，传统上依赖阿片类药物或胸段硬膜外镇痛。在乳房手术中，椎旁阻滞,前锯肌平面块,胸神经阻滞已被证明可以有效控制疼痛，同时尽量减少阿片类药物的使用和相关的副作用。肋骨骨折区域镇痛的选择也在扩大和继续改善。区域麻醉的进展极大地改善了多模式镇痛，并有助于增强手术方案后的恢复。这篇综述提供了关于胸壁阻滞在心胸和乳腺手术中的使用和疗效的最新总结。以及肋骨骨折相关的疼痛和持续的术后疼痛。
结果：随着超声和临床研究的进展，在过去的十年中，区域麻醉技术一直在改进，并且出现了更多应用的新技术。目前在心胸手术中，已经成功地利用了神经轴旁阻滞和胸壁阻滞来补充或替代全身镇痛，传统上依赖阿片类药物或胸段硬膜外镇痛。在乳房手术中，椎旁阻滞,前锯肌平面块,胸神经阻滞已被证明可以有效控制疼痛，同时尽量减少阿片类药物的使用和相关的副作用。肋骨骨折区域镇痛的选择也在扩大和继续改善。区域麻醉的进展极大地改善了多模式镇痛，并有助于增强手术方案后的恢复。这篇综述提供了关于胸壁阻滞在心胸和乳腺手术中的使用和疗效的最新总结。以及肋骨骨折相关的疼痛和持续的术后疼痛。
