Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries in Adults and Children

This Guideline deals with the recommendations of perioperative pain management using local and regional anesthesia for Cardiothoracic surgeries, mastectomy, and abdominal surgeries in adults and children.

Open Truncal Surgeries in Adults

1.     For adults undergoing open cardiothoracic surgeries including lobectomy, aortic valve replacement, coronary artery bypass grafts, mitral valve repair, or septal repair, we recommend fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively. (Strong)

2.     For adults undergoing open abdominal, retroperitoneal, and pelvic surgeries, we recommend fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively. Fascial blocks also improve patient satisfaction. (Strong)

Mastectomy

3.     For adults undergoing mastectomy, we recommend fascial plane or paravertebral blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively. Fascial plane blocks also improve patient satisfaction and quality of recovery. (Strong)

Minimally Invasive Truncal Surgeries in Adults

4.     For adults undergoing minimally invasive cardiothoracic surgeries including lobectomy, valve repair/replacement, and esophageal procedures, we suggest regional techniques including neuraxial and fascial plane blocks to reduce pain in the first 24 h postoperatively. (Conditional)

5.     For adults undergoing minimally invasive abdominal surgeries including cholecystectomy, appendectomy, bariatric, gastrectomy, and liver resection surgeries, we recommend fascial plane blocks to reduce pain and/or opioid requirements in the first 24 h postoperatively. (Strong)

6.     For adults undergoing minimally invasive hernia repair, we suggest fascial plane blocks to reduce pain in the first 24 h postoperatively. (Conditional)

Open Truncal Surgeries in Children (Younger than 18 yr)

7.     For children (younger than 18 yr) undergoing open cardiothoracic surgeries, we recommend fascial plane blocks to reduce pain and/or opioid use in the first 24 h postoperatively. (Strong)

8.     For children (younger than 18 yr) undergoing open hernia repair, we suggest a fascial plane block to reduce pain in the first 24 h postoperatively. (Conditional)