Abstract

Objective: This review aims to provide a synopsis of regional analgesic modalities in the intensive care unit (ICU) context and to evaluate existing literature regarding the benefits and limitations of performing these procedures in critically ill patients. Specifically, we review regional techniques in the setting of traumatic rib fractures and extremity fractures, thoracic surgery, major abdominal surgery, and cardiac surgery. We additionally discuss the limitations of clinical practice in performing regional anesthesia in the ICU setting. Overall, the current literature demonstrates promising benefits of regional analgesia in critically ill patients. However, more extensive high-powered studies are needed to determine optimal analgesic strategies in this tenuous population.

Keywords: Regional anesthesia, intensive care unit, acute pain, pain management, post-traumatic pain

References

  1. Chanques G, Sebbane M, Barbotte E, Viel E, Eledjam JJ, Jaber S. A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology. 2007;107:858-60.
  2. Desbiens NA, Wu AW, Broste SK, Wenger NS, Connors AF Jr, Lynn J, et al. Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatmentm. Crit Care Med. 1996;24:1953-61.
  3. Gélinas C. Management of pain in cardiac surgery ICU patients: have we improved over time? Intensive Crit Care Nurs. 2007;23:298-303.
  4. Bertolini G, Minelli C, Latronico N, Cattaneo A, Mura G, Melotti RM, et al. The use of analgesic drugs in postoperative patients: the neglected problem of pain control in intensive care units. An observational, prospective, multicenter study in 128 Italian intensive care units. Eur J Clin Pharmacol. 2002;58:73-7.
  5. Alderson SM, McKechnie SR. Unrecognised, undertreated, pain in ICU—Causes, effects, and how to do better. Open J Nurs. 2013;03:108–13.
  6. Kemp HI, Laycock H, Costello A, Brett SJ. Chronic pain in critical care survivors: a narrative review. Br J Anaesth. 2019;123:e372-e384.
  7. Mäkinen OJ, Bäcklund ME, Liisanantti J, Peltomaa M, Karlsson S, Kalliomäki ML. Persistent pain in intensive care survivors: a systematic review. Br J Anaesth. 2020;125:149-58.
  8. Puntillo KA, Max A, Chaize M, Chanques G, Azoulay E. Patient Recollection of ICU Procedural Pain and Post ICU Burden: The Memory Study. Crit Care Med. 2016;44:1988-95.
  9. Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, et al. Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med. 2008;36:2801-9.
  10. Puntillo KA, Naidu R. Chronic pain disorders after critical illness and ICU-acquired opioid dependence: two clinical conundra. Curr Opin Crit Care. 2016;22:506-12.
  11. Yamashita A, Yamasaki M, Matsuyama H, Amaya F. Risk factors and prognosis of pain events during mechanical ventilation: a retrospective study. J Intensive Care. 2017;5:17.
  12. Burton AR, Fazalbhoy A, Macefield VG. Sympathetic Responses to Noxious Stimulation of Muscle and Skin. Front Neurol. 2016;7:109.
  13. Akça O, Melischek M, Scheck T, Hellwagner K, Arkiliç CF, Kurz A, et al. Postoperative pain and subcutaneous oxygen tension. Lancet. 1999;354:41-2.
  14. Buggy DJ, Doherty WL, Hart EM, Pallett EJ. Postoperative wound oxygen tension with epidural or intravenous analgesia: a prospective, randomized, single-blind clinical trial. Anesthesiology. 2002;97:952-8.
  15. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131-57.
  16. Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev. 2018;4:CD007105.
  17. Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102:248-57.
  18. Kumar K, Kirksey MA, Duong S, Wu CL. A Review of Opioid-Sparing Modalities in Perioperative Pain Management: Methods to Decrease Opioid Use Postoperatively. Anesth Analg. 2017;125:1749-60.
  19. Singh NP, Makkar JK, Borle A, Singh PM. Role of supplemental regional blocks on postoperative neurocognitive dysfunction after major non-cardiac surgeries: a systematic review and meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2024;49:49-58.
  20. Michetti CP, Fakhry SM, Brasel K, Martin ND, Teicher EJ, Newcomb A, et al. Trauma ICU Prevalence Project: the diversity of surgical critical care. Trauma Surg Acute Care Open. 2019;4:e000288.
  21. Kejela S, Seyoum N. Acute pain management in the trauma patient population: are we doing enough? A prospective observational study. J Trauma Inj. 2022;35:151-8.
  22. Berben SA, Meijs TH, van Dongen RT, van Vugt AB, Vloet LC, Mintjes-de Groot JJ, et al. Pain prevalence and pain relief in trauma patients in the Accident & Emergency department. Injury. 2008;39:578-85.
  23. Paul AK, Smith CM, Rahmatullah M, Nissapatorn V, Wilairatana P, Spetea M, et al. Opioid Analgesia and Opioid-Induced Adverse Effects: A Review. Pharmaceuticals (Basel). 2021;14:1091.
  24. Krantz MJ, Palmer RB, Haigney MCP. Cardiovascular Complications of Opioid Use: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;77:205-23.
  25. Dogrul BN, Kiliccalan I, Asci ES, Peker SC. Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23:125-38.
  26. May L, Hillermann C, Patil S. Rib fracture management. BJA Educ. 2016 Jan;16(1):26–32.
  27. Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, et al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81:936-51.
  28. Peek J, Smeeing DPJ, Hietbrink F, Houwert RM, Marsman M, de Jong MB. Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45:597-622.
  29. Hammal F, Chiu C, Kung JY, Bradley N, Dillane D. Pain management for hospitalized patients with rib fractures: A systematic review of randomized clinical trials. J Clin Anesth. 2024;92:111276.
  30. Duch P, Møller MH. Epidural analgesia in patients with traumatic rib fractures: a systematic review of randomised controlled trials. Acta Anaesthesiol Scand. 2015;59:698-709.
  31. Xiao DL, Xi JW. Efficacy of peripheral nerve blocks for pain management in patients with rib fractures: A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2023;27:899-910.
  32. McKendy KM, Lee LF, Boulva K, Deckelbaum DL, Mulder DS, Razek TS, et al. Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis. J Surg Res. 2017;214:117-23.
  33. Ge YY, Wang XZ, Yuan N, Yuan LY, Ma WH, Hu Y. [Effect of ultrasound guided patient-controlled paravertebral block on pulmonary function in patients with multiple fractured ribs]. Zhonghua Wai Ke Za Zhi. 2016;54:924-8.
  34. Yeying G, Liyong Y, Yuebo C, Yu Z, Guangao Y, Weihu M, et al. Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures. J Int Med Res. 2017;45:2085-91.
  35. Jiang M, Peri V, Ou Yang B, Chang J, Hacking D. Erector Spinae Plane Block as an Analgesic Intervention in Acute Rib Fractures: A Scoping Review. Local Reg Anesth. 2023;16:81-90.
  36. Elawamy A, Morsy MR, Ahmed MAY. Comparison of Thoracic Erector Spinae Plane Block With Thoracic Paravertebral Block for Pain Management in Patients With Unilateral Multiple Fractured Ribs. Pain Physician. 2022;25:483-90.
  37. Armin E, Movahedi M, Najafzadeh MJ, Honarmand A, Rukerd MRZ, Mirafzal A. COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN. J Emerg Med. 2022;63:520-7.
  38. El Malla DA, Helal RAEF, Zidan TAM, El Mourad MB. The Effect of Erector Spinae Block versus Serratus Plane Block on Pain Scores and Diaphragmatic Excursion in Multiple Rib Fractures. A Prospective Randomized Trial. Pain Med. 2022;23:448-55.
  39. Partyka C, Asha S, Berry M, Ferguson I, Burns B, Tsacalos K, et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. JAMA Surg. 2024;159:810-7.
  40. Wallen TE, Singer KE, Makley AT, Athota KP, Janowak CF, Hanseman D, et al. Intercostal liposomal bupivacaine injection for rib fractures: A prospective randomized controlled trial. J Trauma Acute Care Surg. 2022;92:266-76.
  41. Proaño-Zamudio JA, Argandykov D, Renne A, Gebran A, Ouwerkerk JJJ, Dorken-Gallastegi A, et al. Timing of regional analgesia in elderly patients with blunt chest-wall injury. Surgery. 2023;174:901-6.
  42. Alizai Q, Arif MS, Colosimo C, Hosseinpour H, Spencer AL, Bhogadi SK, et al. Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury. 2024;55:111184.
  43. Mukherjee K, Schubl SD, Tominaga G, Cantrell S, Kim B, Haines KL, et al. Non-surgical management and analgesia strategies for older adults with multiple rib fractures: A systematic review, meta-analysis, and joint practice management guideline from the Eastern Association for the Surgery of Trauma and the Chest Wall Injury Society. J Trauma Acute Care Surg. 2023;94:398-407.
  44. Wunsch H, Gershengorn HB, Cooke CR, Guerra C, Angus DC, Rowe JW, et al. Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures. Anesthesiology. 2016;124:899-907.
  45. Abebe K, Negasa T, Argaw F. Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review. Ethiop J Health Sci. 2020;30:725-32.
  46. Ranjeva S, Khoudary A, Kaafarani H, Prout L, Nagrebetsky A, Deng H. 123: Postoperative pain in the ICU: A retrospective cohort study on severity and frequency of assessment. Crit Care Med. 2023 Jan;51(1):44–44.
  47. Mathew A, Lukachan GA, Varughese D, Raju N, Mathai AS, Johnson AS. Impact of frailty and comorbidity index on postoperative complications and functional outcomes among elderly patients undergoing hip fracture surgeries under regional anesthesia techniques. Anaesth Pain Intensive Care. 2023 Apr 25;27(2):161–9.
  48. Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150:e351-e442.
  49. Guay J, Kopp S. Peripheral nerve blocks for hip fractures in adults. Cochrane Database Syst Rev. 2020;11:CD001159.
  50. Laumonerie P, Dalmas Y, Tibbo ME, Robert S, Durant T, Caste T, et al. Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature. Pain Med. 2021;22:1149-57.
  51. Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, et al. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. J Am Geriatr Soc. 2016;64:2433-9.
  52. Wan HY, Li SY, Ji W, Yu B, Jiang N. Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials. Pain Res Manag. 2020;2020:8503963.
  53. Del Buono R, Padua E, Pascarella G, Soare CG, Barbara E. Continuous PENG block for hip fracture: a case series. Reg Anesth Pain Med. 2020;45:835-8.
  54. Acharya U, Lamsal R. Pericapsular Nerve Group Block: An Excellent Option for Analgesia for Positional Pain in Hip Fractures. Case Rep Anesthesiol. 2020;2020:1830136.
  55. Lin DY, Morrison C, Brown B, Saies AA, Pawar R, Vermeulen M, et al. Pericapsular nerve group (PENG) block provides improved short-term analgesia compared with the femoral nerve block in hip fracture surgery: a single-center double-blinded randomized comparative trial. Reg Anesth Pain Med. 2021;46:398-403.
  56. Mosaffa F, Taheri M, Manafi Rasi A, Samadpour H, Memary E, Mirkheshti A. Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical trial. Orthop Traumatol Surg Res. 2022;108:103135.
  57. Desai DJ, Shah N, Bumiya P. Combining Pericapsular Nerve Group (PENG) Block With the Supra-Inguinal Fascia Iliaca Block (SIFICB) for Perioperative Analgesia and Functional Recovery in Patients Undergoing Hip Surgeries: A Retrospective Case Series. Cureus. 2023;15:e36374.
  58. Dangle J, Kukreja P, Kalagara H. Review of current practices of peripheral nerve blocks for hip fracture and surgery. Curr Anesthesiol Rep. 2020;10:259–66.
  59. Cunningham DJ, LaRose MA, Zhang GX, Au S, MacAlpine EM, Paniagua AR, et al. Regional anesthesia reduces inpatient and outpatient perioperative opioid demand in periarticular elbow surgery. J Shoulder Elbow Surg. 2022;31:e48-e57.
  60. Cunningham DJ, LaRose M, Zhang G, Patel P, Paniagua A, Gadsden J, et al. Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery. Anesth Analg. 2022;134:1072-81.
  61. Lantieri MA, Novicoff WM, Yarboro SR. Regional anesthesia provides limited decreases in opioid use following distal tibia and ankle fracture surgery. Eur J Orthop Surg Traumatol. 2023;33:2633–8.
  62. Lee CCM, Beh ZY, Lua CB, Peng K, Fathil SM, Hou JD, Lin JA. Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1-A Scoping Review. Healthcare (Basel). 2022;10:1487.
  63. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, Hogan QH. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009;34:134-70.
  64. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017;42:233-40.
  65. Dhir S, Sondekoppam RV, Sharma R, Ganapathy S, Athwal GS. A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study. Reg Anesth Pain Med. 2016;41:564-71.
  66. Akesen S, Akesen B, Atıcı T, Gurbet A, Ermutlu C, Özyalçın A. Comparison of efficacy between the genicular nerve block and the popliteal artery and the capsule of the posterior knee (IPACK) block for total knee replacement surgery: A prospective randomized controlled study. Acta Orthop Traumatol Turc. 2021;55:134-40.
  67. Chan E, Howle R, Onwochei D, Desai N. Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review. Reg Anesth Pain Med. 2021;46:784-805.
  68. Kang C, Hwang DS, Song JH, Lee GS, Lee JK, Hwang SJ, et al. Clinical analyses of ultrasound-guided nerve block in lower-extremity surgery: A retrospective study. J Orthop Surg (Hong Kong). 2021;29:2309499021989102.
  69. von Keudell AG, Weaver MJ, Appleton PT, Bae DS, Dyer GSM, Heng M, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet. 2015;386:1299–310.
  70. Driscoll EB, Maleki AH, Jahromi L, Hermecz BN, Nelson LE, Vetter IL, et al. Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review. Local Reg Anesth. 2016;9:65–81.
  71. Tran AA, Lee D, Fassihi SC, Smith E, Lee R, Siram G. A systematic review of the effect of regional anesthesia on diagnosis and management of acute compartment syndrome in long bone fractures. Eur J Trauma Emerg Surg. 2020;46:1281–90.
  72. Chen Y-YK, Lirk P, Flowers KM, Colebaugh CA, Wilson JM, Zeballos J, et al. Impact of varying degrees of peripheral nerve blockade on experimental pressure and ischemic pain: adductor canal and sciatic nerve blocks in a human model of compartment syndrome pain. Reg Anesth Pain Med. 2022;47:630–6.
  73. Ivani G, Suresh S, Ecoffey C, Bosenberg A, Lonnqvist P-A, Krane E, et al. The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine joint committee practice advisory on controversial topics in pediatric Regional Anesthesia. Reg Anesth Pain Med. 2015;40:526–32.
  74. Yuan B, Hu D, Gu S, Xiao S, Song F. The global burden of traumatic amputation in 204 countries and territories. Front Public Health. 2023;11:1258853.
  75. Limakatso K, Bedwell GJ, Madden VJ, Parker R. The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysis. PLoS One. 2020;15:e0240431.
  76. Birbaumer N, Lutzenberger W, Montoya P, Larbig W, Unertl K, Töpfner S, et al. Effects of regional anesthesia on phantom limb pain are mirrored in changes in cortical reorganization. J Neurosci. 1997;17:5503–8.
  77. Kukreja P, Paul LM, Sellers AR, Nagi P, Kalagara H. The role of regional anesthesia in the development of chronic pain: A review of literature. Curr Anesthesiol Rep. 2022;12:417–38.
  78. Ilfeld BM, Khatibi B, Maheshwari K, Madison S, Ali Sakr Esa W, Mariano ER, et al. Patient-centered results from a multicenter study of continuous peripheral nerve blocks and postamputation phantom and residual limb pain: secondary outcomes from a randomized, clinical trial. Reg Anesth Pain Med. 2023;48:471–7.
  79. Sengupta S. Post-operative pulmonary complications after thoracotomy. Indian J Anaesth. 2015;59:618–26.
  80. Visser E, Marsman M, van Rossum PSN, Cheong E, Al-Naimi K, van Klei WA, et al. Postoperative pain management after esophagectomy: a systematic review and meta-analysis. Dis Esophagus. 2017;30:1–11.
  81. Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ. 2020;368:m540.
  82. Macrosson D, Beebeejaun A, Odor PM. A systematic review and meta-analysis of thoracic epidural analgesia versus other analgesic techniques in patients post-oesophagectomy. Perioper Med (Lond). 2024;13:80.
  83. Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev. 2018;4:CD007105.
  84. Balzani E, Rosboch GL, Ceraolo E, Lyberis P, Filippini C, Piccioni F, et al. The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials. Tumori. 2023;109:6–18.
  85. Yeung JHY, Gates S, Naidu BV, Wilson MJA, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.
  86. Ding X, Jin S, Niu X, Ren H, Fu S, Li Q. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated meta-analysis. PLoS One. 2014;9:e96233.
  87. Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014;18:626–35.
  88. Xiong C, Han C, Zhao D, Peng W, Xu D, Lan Z. Postoperative analgesic effects of paravertebral block versus erector spinae plane block for thoracic and breast surgery: A meta-analysis. PLoS One. 2021;16:e0256611.
  89. Koo C-H, Lee H-T, Na H-S, Ryu J-H, Shin H-J. Efficacy of erector spinae plane block for analgesia in thoracic surgery: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2022;36:1387–95.
  90. Huang W, Wang W, Xie W, Chen Z, Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth. 2020;66:109900.
  91. Guerra-Londono CE, Privorotskiy A, Cozowicz C, Hicklen RS, Memtsoudis SG, Mariano ER, et al. Assessment of intercostal nerve block analgesia for thoracic surgery: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Netw Open. 2021;4:e2133394.
  92. Lusianawati, Suhardi CJ, Sumartono C, Wungu CDK. Efficacy and safety of the serratus anterior block compared to thoracic epidural analgesia in surgery: Systematic review and meta-analysis. Tzu Chi Med J. 2023;35:329–37.
  93. Liu X, Song T, Xu H-Y, Chen X, Yin P, Zhang J. The serratus anterior plane block for analgesia after thoracic surgery: A meta-analysis of randomized controlled trails. Medicine (Baltimore). 2020;99:e20286.
  94. Jack JM, McLellan E, Versyck B, Englesakis MF, Chin KJ. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia. 2020;75:1372–85.
  95. McLean SR, von Homeyer P, Cheng A, Hall ML, Mulligan MS, Cain K, et al. Assessing the benefits of preoperative thoracic epidural placement for lung transplantation. J Cardiothorac Vasc Anesth. 2018;32:2654–61.
  96. Garcia JP, Ashworth CL, Hage CA. ECMO in lung transplant: pre, intra and post-operative utilization—a narrative review. Curr Chall Thorac Surg. 2022;0:0–0.
  97. Lenz N, Hirschburger M, Roehrig R, Menges T, Mueller M, Padberg W, et al. Application of continuous wound-infusion catheters in lung transplantation: A retrospective data analysis. Thorac Cardiovasc Surg. 2017;65:403–9.
  98. Hutchins J, Apostolidou I, Shumway S, Kelly R, Wang Q, Foster C, et al. Paravertebral catheter use for postoperative pain control in patients after lung transplant surgery: A prospective observational study. J Cardiothorac Vasc Anesth. 2017;31:142–6.
  99. Rigg JRA, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359:1276–82.
  100. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis: A meta-analysis. JAMA. 2003;290:2455–63.
  101. Carver A, Wou F, Pawa A. Do outcomes differ between thoracic epidurals and continuous fascial plane blocks in adults undergoing major abdominal surgery? Curr Anesthesiol Rep. 2023;14:25–41.
  102. Bardia A, Sood A, Mahmood F, Orhurhu V, Mueller A, Montealegre-Gallegos M, et al. Combined epidural-general anesthesia vs general anesthesia alone for elective abdominal aortic aneurysm repair. JAMA Surg. 2016;151:1116–23.
  103. Monaco F, Pieri M, Barucco G, Karpatri V, Redaelli MB, De Luca M, et al. Epidural analgesia in open thoraco-abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2019;57:360–7.
  104. Guay J, Kopp S. Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev. 2016;2017:CD005059.
  105. Greco KJ, Brovman EY, Nguyen LL, Urman RD. The impact of epidural analgesia on perioperative morbidity or mortality after open abdominal aortic aneurysm repair. Ann Vasc Surg. 2020;66:44–53.
  106. Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012;109:144–54.
  107. Holte K, Foss NB, Svensén C, Lund C, Madsen JL, Kehlet H. Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiology. 2004;100:281–6.
  108. Jackson CB, Desai J, Lee WA, Renfro LA. Utility of continuous paravertebral block after retroperitoneal abdominal aortic aneurysm repair. Ann Vasc Surg. 2024;104:124–31.
  109. Minami K, Yoshitani K, Inatomi Y, Sugiyama Y, Iida H, Ohnishi Y. A retrospective examination of the efficacy of paravertebral block for patients requiring intraoperative high-dose unfractionated heparin administration during thoracoabdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2015;29:937–41.
  110. Walker C, Carneiro J, Bersot CDA, Barros V, Aslanidis T. Unilateral erector spinae plane block as adjuvant for open repair of thoracoabdominal aortic aneurysm: Case report and literature review [Internet]. 2023. Available from: https://rgdoi.net/10.13140/RG.2.2.20265.98400
  111. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: Anatomical concepts, mechanisms, and techniques. Anesthesiology. 2019;130:322–35.
  112. Tran DQ, Bravo D, Leurcharusmee P, Neal JM. Transversus Abdominis Plane Block: A Narrative Review. Anesthesiology. 2019;131:1166-90.
  113. Feltracco P, Carollo C, Barbieri S, Milevoj M, Pettenuzzo T, Gringeri E, et al. Pain control after liver transplantation surgery. Transplant Proc. 2014;46:2300–7.
  114. Hausken J, Haugaa H, Hagness M, Line P-D, Melum E, Tønnessen TI. Thoracic epidural analgesia for postoperative pain management in liver transplantation: A 10-year study on 685 liver transplant recipients: A 10-year study on 685 liver transplant recipients. Transplant Direct. 2021;7:e648.
  115. Dieu A, Huynen P, Lavand’homme P, Beloeil H, Freys SM, Pogatzki-Zahn EM, et al. Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations. Reg Anesth Pain Med. 2021;46:433–45.
  116. Ander M, Mugve N, Crouch C, Kassel C, Fukazawa K, Isaak R, et al. Regional anesthesia for transplantation surgery - A White Paper Part 2: Abdominal transplantation surgery. Clin Transplant. 2024;38:e15227.
  117. Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database Syst Rev. 2019;3:CD006715.
  118. Ho AM, Chung DC, Joynt GM. Neuraxial blockade and hematoma in cardiac surgery: estimating the risk of a rare adverse event that has not (yet) occurred. Chest. 2000;117:551–5.
  119. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (fourth edition). Reg Anesth Pain Med. 2018;43:263–309.
  120. Devarajan J, Balasubramanian S, Nazarnia S, Lin C, Subramaniam K. Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery. Semin Cardiothorac Vasc Anesth. 2021;25:252–64.
  121. Naganuma M, Tokita T, Sato Y, Kasai T, Kudo Y, Suzuki N, et al. Efficacy of preoperative bilateral thoracic paravertebral block in cardiac surgery requiring full heparinization: A propensity-matched study. J Cardiothorac Vasc Anesth. 2022;36:477–82.
  122. Scarfe AJ, Schuhmann-Hingel S, Duncan JK, Ma N, Atukorale YN, Cameron AL. Continuous paravertebral block for post-cardiothoracic surgery analgesia: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50:1010–8.
  123. Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth. 2008;100:8–16.
  124. Elsharkawy H, Pawa A, Mariano ER. Interfascial plane blocks: Back to basics. Reg Anesth Pain Med. 2018;43:341–6.
  125. Neal JM, Barrington MJ, Brull R, Hadzic A, Hebl JR, Horlocker TT, et al. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine: Executive summary 2015. Reg Anesth Pain Med. 2015;40:401–30.
  126. Topor B, Oldman M, Nicholls B. Best practices for safety and quality in peripheral regional anaesthesia. BJA Educ. 2020;20:341–7.
  127. Walker BJ, Long JB, Sathyamoorthy M, Birstler J, Wolf C, Bosenberg AT, et al. Complications in pediatric regional anesthesia: An analysis of more than 100,000 blocks from the Pediatric Regional Anesthesia Network: An analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129:721–32.
  128. Ramin S, Bringuier S, Martinez O, Sadek M, Manzanera J, Deras P, et al. Continuous peripheral nerve blocks for analgesia of ventilated critically ill patients with multiple trauma: a prospective randomized study. Anaesth Crit Care Pain Med. 2023;42:101183.
  129. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the prevention and management of Pain, Agitation/sedation, Delirium, Immobility, and Sleep disruption in Adult Patients in the ICU. Crit Care Med. 2018;46:e825–73.
  130. Vincent J-L, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020;323:1478–87.
  131. Selvamani BJ, Kalagara H, Volk T, Narouze S, Childs C, Patel A, et al. Infectious complications following regional anesthesia: a narrative review and contemporary estimates of risk. Reg Anesth Pain Med. 2024;rapm-2024-105496.
  132. Rasouli MR, Cavanaugh PK, Restrepo C, Ceylan HH, Maltenfort MG, Viscusi ER, et al. Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection? Clin Orthop Relat Res. 2015;473:1472–7.
  133. Neuburger M, Büttner J, Blumenthal S, Breitbarth J, Borgeat A. Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand. 2007;51:108–14.
  134. Capdevila X, Pirat P, Bringuier S, Gaertner E, Singelyn F, Bernard N, et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology. 2005;103:1035–45.
  135. Morin AM, Kerwat KM, Klotz M, Niestolik R, Ruf VE, Wulf H, et al. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol. 2005;5:1.
  136. Bomberg H, Kubulus C, Herberger S, Wagenpfeil S, Kessler P, Steinfeldt T, et al. Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis. Br J Anaesth. 2016;116:546–53.
  137. Schmoch T, Möhnle P, Weigand MA, Briegel J, Bauer M, Bloos F, et al. The prevalence of sepsis-induced coagulopathy in patients with sepsis - a secondary analysis of two German multicenter randomized controlled trials. Ann Intensive Care. 2023;13:3.
  138. Derakhshanfar H, Vafaei A, Tabatabaey A, Noori S. Prevalence and associated factors of acute traumatic coagulopathy; A cross sectional study. Emerg (Tehran). 2017;5:e58.
  139. Kietaibl S, Ferrandis R, Godier A, Llau J, Lobo C, Macfarlane A Jr, et al. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol. 2022;39:100–32.
  140. Joubert F, Gillois P, Bouaziz H, Marret E, Iohom G, Albaladejo P. Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: A systematic review. Anaesth Crit Care Pain Med. 2019;38:507–16.
  141. Working Party:; Association of Anaesthetists of Great Britain & Ireland; Obstetric Anaesthetists’ Association; Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of coagulation: the Association of Anaesthetists of Great Britain & Ireland The Obstetric Anaesthetists’ Association Regional Anaesthesia UK. Anaesthesia. 2013;68:966-72.
  142. Arbona FL, Khabiri B, Norton JA. Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters. Cambridge University Press; 2011. 207 p.
  143. Dung-Hung C, Cong T, Zeyu J, Yu-Shan OY, Yung-Yan L. External validation of a machine learning model to predict hemodynamic instability in intensive care unit. Crit Care. 2022;26:215.
  144. Meyhoff CS, Hesselbjerg L, Koscielniak-Nielsen Z, Rasmussen LS. Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients. Eur J Anaesthesiol. 2007;24:770-5.
  145. Wink J, Veering BT, Aarts LPHJ, Wouters PF. Effects of thoracic epidural anesthesia on neuronal cardiac regulation and cardiac function. Anesthesiology. 2019;130:472–91.
  146. Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology. 1995;83:727-37.
  147. Eichenberger U, Giani C, Petersen-Felix S, Graven-Nielsen T, Arendt-Nielsen L, Curatolo M. Lumbar epidural fentanyl: segmental spread and effect on temporal summation and muscle pain. Br J Anaesth. 2003;90:467-73.
  148. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study. J Trauma. 2009;66:1096-101.
  149. Frölich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of midazolam, propofol, and dexmedetomidine in healthy volunteers. J Clin Anesth. 2011;23:218-23.
  150. Tikle HA, Patil BM. Comparison of superficial cervical plexus block versus local infiltration for pain relief during internal jugular vein cannulation. Int J Contemp Med Res [IJCMR] [Internet]. 2018 Sep;5(9).
  151. Lopez-Rincon RM, Kumar V. Ultrasound-guided intercostal nerve block. 2020; Available from: https://www.ncbi.nlm.nih.gov/books/NBK555900/

Copyright and license

Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Hu L, Bhat MA, Jaremko KM. Role of Regional Anesthesia in Intensive Care: An Updated Narrative Review. Turk J Intensive Care. 2024;22(4):225-238. https://doi.org/10.4274/tybd.galenos.2024.50490