Paravertebral analgesia for cardiac surgery

High-quality analgesia following cardiac surgery is infrequently obtained. Pain management is seldom a priority in the immediate postoperative care of these patients, who frequently require mechanical ventilation in an intensive care environment. These patients may be physiologically unstable, and attention to hemostasis and cardiopulmonary stability is usually of more concern in the initial phases of their care. Nevertheless, there are several compelling physiological, psychological, and humanitarian reasons that good pain relief should be offered to these patients. The frequently misguided perception that cardiac surgery is not painful, and the valid concerns many have regarding the side effects of opioid analgesia as well as the potential risks of thoracic epidural analgesia contribute to “oligoanalgesia” in the patient recovering from cardiac surgery. The evolution of minimally invasive cardiac surgery and the increasing clinical complexity of cardiac patients are providing an impetus to explore safe and effective analgesic techniques in this clinical domain. The role of paravertebral blockade in cardiac surgery has not been extensively investigated. At best, the literature to date is in the form of isolated case reports and observational studies. As such, a meaningful review of this topic can offer little more than commentary and discussion. However, paravertebral blockade has an established role in postoperative analgesia in general, and it confers some theoretical advantages over both conventional thoracic epidural analgesia as well as parenteral opioid therapy for cardiac patients.