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

1.      Joshi, GP, Mariano; Elkassabany, et al. 2026 American Society of Anesthesiologists Practice Guideline on Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries. Anesthesiology 144(1):p 19-43, January 2026. | DOI: 10.1097/ALN.0000000000005790

2.      Mariano ER, Dickerson DM, Szokol JW, et al.: A multi-society organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med 2022; 47:118–27. doi:10.1136/rapm-2021-103083

3.      Joshi GP, Kehlet H, Lobo DN: Nonsteroidal anti-inflammatory drugs in the perioperative period: Current controversies and concerns. Br J Anaesth 2025; 134:294–6. doi:10.1016/j.bja.2024.10.018

4.      El-Boghdadly K, Levy NA, Fawcett WJ, et al.: Peri-operative pain management in adults: A multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society. Anaesthesia 2024; 79:1220–36. doi:10.1111/anae.16391

5.      Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W: Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures. Anesthesiology 2013; 118:934–44. doi:10.1097/ALN.0b013e31828866b3

6.      Balan C, Tomescu DR, Valeanu L, et al.: Nociception level index-directed erector spinae plane block in open heart surgery: A randomized controlled clinical trial. Medicina (Kaunas) 2022; 58:1462. doi:10.3390/medicina58101462

7.      Chen S, Zhang H, Zhang Y: Effect of transverse thoracic muscle plane block on postoperative cognitive dysfunction after open cardiac surgery: A randomized clinical trial. J Cell Mol Med 2023; 27:976–81. doi:10.1111/jcmm.17710

8.      Hamed MA, Boules ML, Sobhy MM, Abdelhady MA: The analgesic efficacy of ultrasound-guided bilateral transversus thoracic muscle plane block after open-heart surgeries: A randomized controlled study. J Pain Res 2022; 15:675–82. doi:10.2147/JPR.S355231

9.      Saad FS, El Baradie SY, Abdel Aliem MAW, Ali MM, Kotb TAM: Ultrasound-guided serratus anterior plane block versus thoracic paravertebral block for perioperative analgesia in thoracotomy. Saudi J Anaesth 2018; 12:565–70. doi:10.4103/sja.SJA_153_18

10.   Sarhan K, Elshemy A, Mamdouh S, et al.: Effect of bilateral erector spinae plane block versus fentanyl infusion on postoperative recovery in cardiac surgeries via median sternotomy: A randomized controlled trial. J Cardiothorac Vasc Anesth 2024; 38:2668–74. doi:10.1053/j.jvca.2024.07.041

11.   Aydin ME, Ahiskalioglu A, Ates I, et al.: Efficacy of ultrasound-guided transversus thoracic muscle plane block on postoperative opioid consumption after cardiac surgery: A prospective, randomized, double-blind study. J Cardiothorac Vasc Anesth 2020; 34:2996–3003. doi:10.1053/j.jvca.2020.06.044

12.   Hamed MA, Abdelhady MA, Hassan A, Boules ML: The analgesic effect of ultrasound-guided bilateral pectointercostal fascial plane block on sternal wound pain after open heart surgeries: A randomized controlled study. Clin J Pain 2022; 38:279–84. doi:10.1097/AJP.0000000000001022

13.   Hassan ME, Wadod MAA: Serratus anterior plane block and erector spinae plane block in postoperative analgesia in thoracotomy: A randomised controlled study. Indian J Anaesth 2022; 66:119–25. doi:10.4103/ija.ija_257_21

14.   Ozturk NK, Baki ED, Kavakli AS, et al.: Comparison of transcutaneous electrical nerve stimulation and parasternal block for postoperative pain management after cardiac surgery. Pain Res Manag 2016; 2016:4261949. doi:10.1155/2016/4261949

15.   Shokri H, Ali I, Kasem AA: Evaluation of the analgesic efficacy of bilateral ultrasound-guided transversus thoracic muscle plane block on post-sternotomy pain: A randomized controlled trial. Local Reg Anesth 2021; 14:145–52. doi:10.2147/LRA.S338685

16.   Hu Z, Zhou Y, Zhao G, et al.: Effects of quadratus lumborum block on perioperative multimodal analgesia and postoperative outcomes in patients undergoing radical prostatectomy. BMC Anesthesiol 2022; 22:213. doi:10.1186/s12871-022-01755-w

17.   Kim Y, Kim JT, Yang SM, et al.: Anterior quadratus lumborum block for analgesia after living-donor renal transplantation: A double-blinded randomized controlled trial. Reg Anesth Pain Med 2024; 49:550–7. doi:10.1136/rapm-2023-104788

18.   Prasad M, Rani K, Jain P, Varshney R, Jheetay G, Bhadani U: Peripheral nerve stimulator guided erector spinae plane block for post-operative analgesia after total abdominal hysterectomies: A feasibility study. Indian J Anaesth 2021; 65:S149–55. doi:10.4103/ija.IJA_69_21

19.   Shukla U, Kumari P, Yadav JBS, Kumar A: Ultrasound guided quadratus lumborum block versus transversus abdominis plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy—A RCT. J Clin Diagn Res 2021; 15:UC1–5. doi:10.7860/jcdr/2021/46063.14494

20.   Qazi N, Bhat WM, Iqbal MZ, Wani AR, Gurcoo SA, Rasool S: Postoperative analgesic efficacy of bilateral transversus abdominis plane block in patients undergoing midline colorectal surgeries using ropivacaine: A randomized, double-blind, placebo-controlled trial. Anesth Essays Res 2017; 11:767–72. doi:10.4103/0259-1162.194577

21.   Altlparmak B, Toker MK, Uysal AI, Dere O, Ugur B: Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: A prospective, randomized controlled trial. Reg Anesth Pain Med 2020; 45:277–82. doi:10.1136/rapm-2019-101114

22.   Mohsin MH, Verma R, Hemlata, Singh D, Singh S, Singh K: Effect of erector spinae block and pectoralis block on quality of recovery and analgesia after modified radical mastectomy: A randomised controlled study. Sultan Qaboos Univ Med J 2023; 23:220–6. doi:10.18295/squmj.9.2022.057

23.   Yao Y, Li J, Hu H, Xu T, Chen Y: Ultrasound-guided serratus plane block enhances pain relief and quality of recovery after breast cancer surgery: A randomized controlled trial. Eur J Anaesthesiol 2019; 36:436–41. doi:10.1097/EJA.0000000000001004

24.   Amr SA, Othman AH, Ahmed EH, Naeem RG, Kamal SM: Comparison between ultrasound guided erector spinae plane block and paravertebral block on acute and chronic post mastectomy pain after modified radical mastectomy: Randomized controlled trial. BMC Anesthesiol 2024; 24:420. doi:10.1186/s12871-024-02810-4

25.   Deng W, Fu D, He L: Evaluation of pectoral nerve block in modified radical mastectomy: Comparison of three concentrations of ropivacaine. Clin Interv Aging 2020; 15:937–44. doi:10.2147/CIA.S251613

26.   Qian B, Huang S, Liao X, Wu J, Lin Q, Lin Y: Serratus anterior plane block reduces the prevalence of chronic postsurgical pain after modified radical mastectomy: A randomized controlled trial. J Clin Anesth 2021; 74:110410. doi:10.1016/j.jclinane.2021.110410

27.   Wong HY, Pilling R, Young BWM, Owolabi AA, Onwochei DN, Desai N: Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis. J Clin Anesth 2021; 72:110274. doi:10.1016/j.jclinane.2021.110274

28.   Southwell B, Brandt S, Choconta-Piraquive LA, et al.: Peripheral nerve blocks for postoperative pain management in cardiothoracic surgery. Systematic review (prepared by Minnesota evidence-based practice center under contract no. 75q80124f32011), 2025. Agency for Healthcare Research and Quality, Rockville, Maryland. Report No. 25-EHC028. Available at: https://effectivehealthcare.ahrq.gov/products/peripheral-nerve-blocks/research. Accessed September 24, 2025.

29.   Hoogma DF, Van den Eynde R, Al Tmimi L, et al.: Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: Results of a double-blind, prospective randomized placebo-controlled trial. J Clin Anesth 2023; 86:111072. doi:10.1016/j.jclinane.2023.111072

30.   Hoogma DF, Van den Eynde R, Oosterlinck W, et al.: Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: Results of a randomized placebo-controlled trial. J Clin Anesth 2023; 87:111088. doi:10.1016/j.jclinane.2023.111088

31.   Zhang S, Han X, Zhou D, et al.: The effects of erector spinae plane block on perioperative opioid consumption and rehabilitation in video assisted thoracic surgery. BMC Anesthesiol 2021; 21:313. doi:10.1186/s12871-021-01536-x

32.   Liu W, Wang F, Luo T, et al.: The effects of programmed intermittent paravertebral bolus infusion on postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery: A prospective, randomized, controlled study. J Cardiothorac Vasc Anesth 2022; 36:3637–44. doi:10.1053/j.jvca.2022.05.006

33.   Wei W, Zheng X, Gu Y, Fu W, Tang C, Yao Y: Effect of general anesthesia with thoracic paravertebral block on postoperative delirium in elderly patients undergoing thoracoscopic lobectomy: A randomized-controlled trial. BMC Anesthesiol 2022; 22:1. doi:10.1186/s12871-021-01532-1

34.   Wu Z, Fang S, Wang Q, Wu C, Zhan T, Wu M: Patient-controlled paravertebral block for video-assisted thoracic surgery: A randomized trial. Ann Thorac Surg 2018; 106:888–94. doi:10.1016/j.athoracsur.2018.04.036

35.   Feray S, Lubach J, Joshi GP, Bonnet F, Van de Velde M; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy: Prospect guidelines for video-assisted thoracoscopic surgery: A systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2022; 77:311–25. doi:10.1111/anae.15609

36.   Zardo P: Do we still need thoracic epidural analgesia in minimally invasive lung surgery? J Thorac Dis 2022; 14:3105–7. doi:10.21037/jtd-2022-14

37.   Patil M Jr, Gharde P, Reddy K, Nayak K: Comparative analysis of laparoscopic versus open procedures in specific general surgical interventions. Cureus 2024; 16:e54433. doi:10.7759/cureus.54433

38.   Wei K, Cheng L, Zheng Q, Tian J, Liu R, Hackert T: Minimally invasive surgery versus open surgery for total pancreatectomy: A bibliometric review and meta-analysis. HPB (Oxford) 2023; 25:723–31. doi:10.1016/j.hpb.2023.01.012

39.   Berger Y, Khajoueinejad N, Imtiaz S, et al.: Robotic colorectal resections are associated with less postoperative pain, decreased opioid use, and earlier return to work as compared to the laparoscopic approach. J Robot Surg 2024; 18:336. doi:10.1007/s11701-024-02054-x

40.   Rashid Z, Woldesenbet S, Munir MM, et al.: Open versus minimally invasive surgery: Risk of new persistent opioid use. J Gastrointest Surg 2025; 29:101873. doi:10.1016/j.gassur.2024.10.028

41.   Kwak KH, Baek SI, Kim JK, Kim TH, Yeo J: Analgesic effect of ultrasound-guided preoperative unilateral lateral quadratus lumborum block for laparoscopic nephrectomy: A randomized, double-blinded, controlled trial. J Pain Res 2020; 13:1647–54. doi:10.2147/JPR.S257466

42.   Zhu Y, Li Z, Qin S, et al.: Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study. Front Oncol 2022; 12:969452. doi:10.3389/fonc.2022.969452

43.   Cui XL, Li X, Li MN, et al.: Ultrasound-guided transmuscular quadratus lumbar block reduces opioid consumption after laparoscopic partial nephrectomy. Chin Med Sci J 2020; 35:289–96. doi:10.24920/003759

44.   Bilge A, Başaran B, Et T, et al.: Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (m-tapa) in patients undergoing laparoscopic cholecystectomy: A randomized double-blind controlled trial. BMC Anesthesiol 2022; 22:329. doi:10.1186/s12871-022-01866-4

45.   Canitez A, Kozanhan B, Aksoy N, Yildiz M, Tutar MS: Effect of erector spinae plane block on the postoperative quality of recovery after laparoscopic cholecystectomy: A prospective double-blind study. Br J Anaesth 2021; 127:629–35. doi:10.1016/j.bja.2021.06.030

46.   Jung J, Jung W, Ko EY, et al.: Impact of bilateral subcostal plus lateral transversus abdominis plane block on quality of recovery after laparoscopic cholecystectomy: A randomized placebo-controlled trial. Anesth Analg 2021; 133:1624–32. doi:10.1213/ANE.0000000000005762

47.   Toprak H, Başaran B, Toprak SS, et al.: Efficacy of the erector spinae plane block for quality of recovery in bariatric surgery: A randomized controlled trial. Obes Surg 2023; 33:2640–51. doi:10.1007/s11695-023-06748-3

48.   Wang Y, Zuo S, Ma Y, Shen J, Chu Q, Yang Z: Effect of ultrasound-guided erector spinae plane block on recovery after laparoscopic sleeve gastrectomy in patients with obesity: A randomized controlled trial. Clin Ther 2023; 45:894–900. doi:10.1016/j.clinthera.2023.07.010

49.   Boezaart AP, Smith CR, Chembrovich S, et al.: Visceral versus somatic pain: An educational review of anatomy and clinical implications. Reg Anesth Pain Med 2021; 46:629–36. doi:10.1136/rapm-2020-102084

50.   Chin KJ, Lirk P, Hollmann MW, Schwarz SKW: Mechanisms of action of fascial plane blocks: A narrative review. Reg Anesth Pain Med 2021; 46:618–28. doi:10.1136/rapm-2020-102305

51.   Abdelbaser II, Mageed NA: Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: A randomized, double-blind, controlled study. J Clin Anesth 2020; 67:110002. doi:10.1016/j.jclinane.2020.110002

52.   Abdelbaser I, Mageed NA, Elfayoumy SI, Magdy M, Elmorsy MM, ALseoudy MM: The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: A randomized controlled double-blind study. Korean J Anesthesiol 2022; 75:276–82. doi:10.4097/kja.2146

53.   Ahmed SG, Salama MA, Elgamal MAF, Ghanem MAL, Elmotlb EAA: Pain management of pecto-intercostal fascial block versus intravenous fentanyl after pediatric cardiac surgery. J Popul Ther Clin Pharmacol 2023; 30:e26–5. doi:10.47750/jptcp.2023.30.11.004

54.   Gado AA, Abdalwahab A, Ali H, Alsadek WM, Ismail AA: Serratus anterior plane block in pediatric patients undergoing thoracic surgeries: A randomized controlled trial. J Cardiothorac Vasc Anesth 2022; 36:2271–7. doi:10.1053/j.jvca.2021.09.014

55.   Kamal F, Abd El-Rahman A, Hassan RM, Helmy AF: Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia. Egyptian J Anaesth 2022; 38:150–7. doi:10.1080/11101849.2022.2043523

56.   Karacaer F, Biricik E, Ilginel M, Tunay D, Topcuoglu S, Unlugenc H: Bilateral erector spinae plane blocks in children undergoing cardiac surgery: A randomized, controlled study. J Clin Anesth 2022; 80:110797. doi:10.1016/j.jclinane.2022.110797

57.   Mogahed MM, Abd El-Ghaffar MS, Elkahwagy MS: Bilateral ultrasound-guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. Ann Card Anaesth 2024; 27:316–23. doi:10.4103/aca.aca_210_23

58.   Abd El-Aziz FKE, Abd El-Tawab SM, Abd El-Aal IT, Fouad Hafez A: Ultrasound-guided erector spinae plane block: A comparative study to assess its analgesic efficacy in pediatric patients undergoing aortic coarctation repair. J Cell Mol Anesth 2023; 8:177–86. doi:10.22037/jcma.v8i3.39827

59.   He Y, Xu M, Li Z, Deng L, Kang Y, Zuo Y: Safety and feasibility of ultrasound-guided serratus anterior plane block and intercostal nerve block for management of post-sternotomy pain in pediatric cardiac patients: A prospective, randomized trial. Anaesth Crit Care Pain Med 2023; 42:101268. doi:10.1016/j.accpm.2023.101268

60.   Guan J, Liu L, Yang Y, Zheng Z, Li J, Zheng Z: Erector spinae plane block versus caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair: A randomized controlled trial. Ann Med 2023; 55:2298868. doi:10.1080/07853890.2023.2298868

61.   Mostafa SF, Abdelghany MS, Elyazed MMA: Analgesic efficacy of ultrasound guided quadratus lumborum block versus ilioinguinal/iliohypogastric nerve block following pediatric open inguinal hernia repair: A prospective randomized controlled trial. J Anaesthesiol Clin Pharmacol 2023; 39:134–40. doi:10.4103/joacp.joacp_127_21

62.   Suresh S, Long J, Birmingham PK, De Oliveira GS Jr: Are caudal blocks for pain control safe in children? An analysis of 18,650 caudal blocks from the pediatric regional anesthesia network (PRAN) database. Anesth Analg 2015; 120:151–6. doi:10.1213/ANE.0000000000000446