كتاب
Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries in Adults and Children
- Annexes
Annex 1:
Evidence-to-Decision Tables
Open Truncal Surgeries in Adults
1. Fascial plane blocks for open cardiothoracic surgeries
|
Criterion |
Fascial plane blocks for open cardiothoracic surgeries |
|
Problem |
Postoperative pain and high opioid requirements in the first 24 h. |
|
Benefit |
Reduction in pain intensity and opioid use; improved recovery. |
|
Risk/Harm |
Minimal: procedural risks of block. |
|
Certainty of Evidence |
Moderate — ASA 2026 guideline; 5 RCTs + 8 trials. |
|
Values & Preferences |
Patients value pain relief and reduced opioid side effects. |
|
Resource Use |
Low to moderate (requires a trained anesthesiologist). |
|
Equity |
High: applicable across institutions. |
|
Acceptability |
High: widely accepted in practice. |
|
Feasibility |
High: feasible with standard perioperative resources. |
|
Recommendation |
Strong. |
2. Fascial plane blocks for open abdominal/retroperitoneal/pelvic surgeries
|
Criterion |
Fascial plane blocks for open abdominal surgeries |
|
Problem |
Significant postoperative pain and opioid use. |
|
Benefit |
Reduction in pain and opioid requirements; improved patient satisfaction. |
|
Risk/Harm |
Minimal procedural risks. |
|
Certainty of Evidence |
Moderate — pooled analysis of 22 RCTs + 5 trials. |
|
Values & Preferences |
Patients value pain control and satisfaction. |
|
Resource Use |
Low to moderate. |
|
Equity |
High. |
|
Acceptability |
High. |
|
Feasibility |
High. |
|
Recommendation |
Strong. |
Mastectomy
3. Fascial plane or paravertebral blocks
|
Criterion |
Fascial plane or paravertebral blocks for mastectomy |
|
Problem |
Severe postoperative pain and opioid dependence. |
|
Benefit |
Effective analgesia, reduced opioid use, improved satisfaction, and recovery. |
|
Risk/Harm |
Minimal procedural risks. |
|
Certainty of Evidence |
Moderate — pooled analysis of 44 RCTs (pain) + 23 trials (opioid use). |
|
Values & Preferences |
Patients value pain relief and quality of recovery. |
|
Resource Use |
Moderate (requires expertise in block techniques). |
|
Equity |
High. |
|
Acceptability |
High. |
|
Feasibility |
High. |
|
Recommendation |
Strong. |
Minimally Invasive Truncal Surgeries in Adults
4. Cardiothoracic (lobectomy, valve repair/replacement, esophageal)
|
Criterion |
Regional techniques (neuraxial/fascial plane blocks) |
|
Problem |
Postoperative pain in minimally invasive cardiothoracic surgery. |
|
Benefit |
Reduction in pain intensity. |
|
Risk/Harm |
Procedural risks; limited evidence of benefit. |
|
Certainty of Evidence |
Low — pooled analyses of 26 trials for fascial plane + 12 trials for continuous epidural & 6 trials for paravertebral blocks. |
|
Values & Preferences |
Patients value pain relief. |
|
Resource Use |
Moderate. |
|
Equity |
High. |
|
Acceptability |
Moderate. |
|
Feasibility |
Moderate. |
|
Recommendation |
Conditional. |
5. Minimally invasive abdominal surgeries (cholecystectomy, appendectomy, bariatric, gastrectomy, liver resection)
|
Criterion |
Fascial plane blocks |
|
Problem |
Postoperative pain and opioid use. |
|
Benefit |
Reduction in pain and opioid requirements. |
|
Risk/Harm |
Minimal. |
|
Certainty of Evidence |
Moderate — pooled analysis of 62 RCTs. |
|
Values & Preferences |
Patients value pain relief and reduced opioid side effects. |
|
Resource Use |
Low to moderate. |
|
Equity |
High. |
|
Acceptability |
High. |
|
Feasibility |
High. |
|
Recommendation |
Strong. |
6. Minimally invasive hernia repair
|
Criterion |
Fascial plane blocks |
|
Problem |
Postoperative pain in hernia repair. |
|
Benefit |
Reduction in pain intensity. |
|
Risk/Harm |
Minimal. |
|
Certainty of Evidence |
Low — 4 trials. |
|
Values & Preferences |
Patients value pain relief. |
|
Resource Use |
Low. |
|
Equity |
High. |
|
Acceptability |
Moderate. |
|
Feasibility |
Moderate. |
|
Recommendation |
Conditional. |
Open Truncal Surgeries in Children (<18 years)
7. Open cardiothoracic surgeries
|
Criterion |
Fascial plane blocks for children |
|
Problem |
Severe postoperative pain and opioid use in pediatric patients. |
|
Benefit |
Reduction in pain and opioid requirements. |
|
Risk/Harm |
Minimal procedural risks. |
|
Certainty of Evidence |
Moderate — 7 trials for reduced opioid use and 6 trials for pain reduction. |
|
Values & Preferences |
Families and patients value pain relief and safety. |
|
Resource Use |
Moderate. |
|
Equity |
High. |
|
Acceptability |
High. |
|
Feasibility |
High. |
|
Recommendation |
Strong. |
8. Open hernia repair in children
|
Criterion |
Fascial plane block for pediatric hernia repair |
|
Problem |
Postoperative pain in pediatric hernia repair. |
|
Benefit |
Reduction in pain intensity. |
|
Risk/Harm |
Minimal. |
|
Certainty of Evidence |
Low — limited pediatric trials – 2 RCTs |
|
Values & Preferences |
Families value pain relief and safety. |
|
Resource Use |
Low. |
|
Equity |
High. |
|
Acceptability |
Moderate. |
|
Feasibility |
Moderate. |
|
Recommendation |
Conditional. |
Annex 2:
Chest Wall Fascial Plane Blocks |
Abdominal Wall Fascial Plane Blocks |
Erector spinae plane blockInterpectoral plane block Parasternal intercostal plane block Pectoserratus plane block Serratus anterior plane block |
External oblique intercostal plane blockRectus sheath block Rhomboid intercostal plane block Transversus abdominis plane block Quadratus lumborum block |
Table: Examples of ultrasound-guided fascial plane blocks indicated for surgeries involving the chest and abdomen [1].
