ISSN: 1859 - 2872
Ứng dụng của gây tê vùng trong kiểm soát đau sau phẫu thuật tim với tuần hoàn ngoài cơ thể
Main Article Content
Keywords
Gây tê vùng, kiểm soát đau, phẫu thuật tim, tuần hoàn ngoài cơ thể
Tóm tắt
Đau sau phẫu thuật tim với tuần hoàn ngoài cơ thể (THNCT) là vấn đề phức tạp và đa yếu tố. Đau không được kiểm soát đầy đủ sẽ gây ra nhiều biến chứng cũng như ảnh hưởng nghiêm trọng đến tâm lý và quá trình hồi phục của bệnh nhân. Trước đây, thuốc phiện là nền tảng trong gây mê tim và kiểm soát đau sau phẫu thuật. Tuy nhiên, loại thuốc này đi kèm với nhiều tác dụng không mong muốn và dễ bị phụ thuộc. Trong những năm gần đây, gây tê vùng ngày càng được ứng dụng để kiểm soát đau sau phẫu thuật giúp giảm sử dụng thuốc phiện cũng như các tác dụng không mong muốn và đem lại cho bệnh nhân sự hài lòng hơn. Bài báo cáo này tổng quan cơ chế gây đau và ứng dụng của gây tê vùng trong kiểm soát đau sau phẫu thuật tim với THNCT. Từ đó, sẽ giúp hiểu rõ hơn về vai trò của gây tê vùng trong kiểm soát đau và mở ra một hướng mới giúp kiểm soát đau sau phẫu thuật tim với THNCT hiệu quả và toàn diện hơn.
Article Details
Các tài liệu tham khảo
1. Jayakumar S, Borrelli M, Milan Z, Kunst G, Whitaker D (2019) Optimising pain management protocols following cardiac surgery: A protocol for a national quality improvement study. Int J Surg Protoc 14: 1-8. doi:10.1016/j.isjp.2018.12.002.
2. Horn R, Hendrix JM, Kramer J (2025) Postoperative Pain Control. StatPearls. StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.
3. Zubrzycki M, Liebold A, Skrabal C et al (2028) Assessment and pathophysiology of pain in cardiac surgery. J Pain Res 11: 1599-1611. doi:10.2147/jpr.S162067.
4. Krakowski JC, Hallman MJ, Smeltz AM (2021) Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth 25(4): 289-300. doi: 10.1177/10892532211041320.
5. Ochroch J, Usman A, Kiefer J et al (2021) Reducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative, Intraoperative, and Critical Care Strategies. J Cardiothorac Vasc Anesth 35(7): 2155-2165. doi: 10.1053/j.jvca.2020.09.103.
6. Jiang T, Ting A, Leclerc M, Calkins K, Huang J (2021) Regional Anesthesia in Cardiac Surgery: A Review of the Literature. Cureus 13(10): 18808. doi:10.7759/cureus.18808.
7. Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D (2020) Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg 131(1): 127-135. doi:10.1213/ane.0000000000004682.
8. Raja SN, Carr DB, Cohen M et al (2020) The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain 161(9): 1976-1982. doi:10.1097/j.pain.0000000000001939.
9. Grant MC, Chappell D, Gan TJ, Manning MW, Miller TE, Brodt JL (2023) Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. J Thorac Cardiovasc Surg 166(6): 1695-1706. doi:10.1016/j.jtcvs.2023.01.020.
10. Fernandes RM, Pontes JPJ, Rezende Borges CE et al (2024) Multimodal Analgesia Strategies for Cardiac Surgery: A Literature Review. Hearts 5(3): 349-364.
11. Smith S, Sarier K, Yeom R, Choe I (2023) Regional Anesthesia for Cardiac Surgery. In: Martinez Hurtado ED, de Luis Cabezón N, Fernández-Vaquero MÁ, eds. Advances in Regional Anesthesia - Future Directions in the Use of Regional Anesthesia. IntechOpen.
12. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT (2018) 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 43(3): 263-309. doi:10.1097/aap.0000000000000763.
13. Sepolvere G, Marianello D, Santonocito C et al (2025) Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era? Journal of Clinical Medicine 14(3): 973.
14. Hong B, Oh C, Jo Y, Lee S, Park S, Kim YH (2022) Current evidence of ultrasound-guided fascial plane blocks for cardiac surgery: a narrative literature review. Korean J Anesthesiol 75(6): 460-472. doi: 10.4097/kja.22564.
15. Capuano P, Sepolvere G, Toscano A et al (2024) Fascial plane blocks for cardiothoracic surgery: A narrative review. J Anesth Analg Crit Care 4(1):20. doi:10.1186/s44158-024-00155-5.
16. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ (2016) The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med 41(5): 621-627. doi:10.1097/aap.0000000000000451.
17. Sharma V, Atluri H (2024) Comparison of Continuous Thoracic Epidural Analgesia Versus Bilateral Erector Spinae Plane Block for Pain Management in Coronary Bypass Surgery. Cureus 16(8): 67149. doi: 10.7759/cureus.67149.
18. Krishna SN, Chauhan S, Bhoi D et al (2019) Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 33(2): 368-375. doi: 10.1053/j.jvca.2018.05.050.
19. Blanco R (2011) The 'pecs block': a novel technique for providing analgesia after breast surgery. Anaesthesia 66(9): 847-848. doi:10.1111/j.1365-2044.2011.06838.x.
20. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 59(9): 470-475. doi:10.1016/j.redar.2012.07.003.
21. Kumar KN, Kalyane RN, Singh NG et al (2018) Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery. Ann Card Anaesth. 21(3): 333-338. doi:10.4103/aca.ACA_15_18.
22. Magoon R, Kaushal B, Chauhan S, Bhoi D, Bisoi AK, Khan MA (2020) A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth 64(12): 1018-1024. doi: 10.4103/ija.IJA_566_20.
23. El Shora HA, El Beleehy AA, Abdelwahab AA et al (2020) Bilateral paravertebral block versus thoracic epidural analgesia for pain control post-cardiac surgery: A randomized controlled trial. Thorac Cardiovasc Surg 68(5): 410-416. doi:10.1055/s-0038-1668496.
24. Vandenbrande J, Jamaer B, Stessel B et al (2024) Serratus plane block versus standard of care for pain control after totally endoscopic aortic valve replacement: a double-blind, randomized controlled, superiority trial. Reg Anesth Pain Med 49(6): 429-435. doi:10.1136/rapm-2023-104439.
25. Aydin ME, Ahiskalioglu A, Ates I et al (2020) 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 34(11): 2996-3003. doi:10.1053/j.jvca.2020.06.044.
26. Kaya C, Dost B, Dokmeci O, Yucel SM, Karakaya D (2020) Comparison of Ultrasound-Guided Pecto-intercostal Fascial Block and Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind Pilot Study. J Cardiothorac Vasc Anesth 36(8 Pt A): 2313-2321. doi:10.1053/j.jvca.2021.09.041.
27. Zhang Y, Min J, Chen S (2022) Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial. Pain Med. 23(3): 440-447. doi: 10.1093/pm/pnab291.
28. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 68(11): 1107-1113. doi:10.1111/anae.12344.
29. Chin KJ, Versyck B, Pawa A (2021) Ultrasound-guided fascial plane blocks of the chest wall: A state-of-the-art review. Anaesthesia 76(1): 110-126. doi:10.1111/anae.15276.
30. Sertcakacilar G, Tire Y, Kelava M et al (2022) Regional anesthesia for thoracic surgery: A narrative review of indications and clinical considerations. J Thorac Dis 14(12): 5012-5028. doi:10.21037/jtd-22-599.
31. Walker JW, Cios TJ (2025) Local Anesthetic Choice for Regional Techniques in Cardiac Surgery: The Sauce Matters. J Cardiothorac Vasc Anesth 39(1): 8-12. doi:10.1053/j.jvca.2024.10.029.
32. Kirksey MA, Haskins SC, Cheng J, Liu SS (2015) Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 10(9): 0137312. doi:10.1371/journal.pone.0137312.
33. Chin KJ (2019) Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence. Best Pract Res Clin Anaesthesiol 33(1): 67-77. doi:10.1016/j.bpa.2019.02.003.
34. Song K, Xu Q, Knott VH et al (2021) Liposomal Bupivacaine-Based Erector Spinae Block for Cardiac Surgery. J Cardiothorac Vasc Anesth 35(5): 1555-1559. doi:10.1053/j.jvca.2020.09.115.
35. El-Boghdadly K, Pawa A, Chin KJ (2018) Local anesthetic systemic toxicity: Current perspectives. Local Reg Anesth 11: 35-44. doi:10.2147/lra.S154512.
2. Horn R, Hendrix JM, Kramer J (2025) Postoperative Pain Control. StatPearls. StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.
3. Zubrzycki M, Liebold A, Skrabal C et al (2028) Assessment and pathophysiology of pain in cardiac surgery. J Pain Res 11: 1599-1611. doi:10.2147/jpr.S162067.
4. Krakowski JC, Hallman MJ, Smeltz AM (2021) Persistent Pain After Cardiac Surgery: Prevention and Management. Semin Cardiothorac Vasc Anesth 25(4): 289-300. doi: 10.1177/10892532211041320.
5. Ochroch J, Usman A, Kiefer J et al (2021) Reducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative, Intraoperative, and Critical Care Strategies. J Cardiothorac Vasc Anesth 35(7): 2155-2165. doi: 10.1053/j.jvca.2020.09.103.
6. Jiang T, Ting A, Leclerc M, Calkins K, Huang J (2021) Regional Anesthesia in Cardiac Surgery: A Review of the Literature. Cureus 13(10): 18808. doi:10.7759/cureus.18808.
7. Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D (2020) Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg 131(1): 127-135. doi:10.1213/ane.0000000000004682.
8. Raja SN, Carr DB, Cohen M et al (2020) The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain 161(9): 1976-1982. doi:10.1097/j.pain.0000000000001939.
9. Grant MC, Chappell D, Gan TJ, Manning MW, Miller TE, Brodt JL (2023) Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. J Thorac Cardiovasc Surg 166(6): 1695-1706. doi:10.1016/j.jtcvs.2023.01.020.
10. Fernandes RM, Pontes JPJ, Rezende Borges CE et al (2024) Multimodal Analgesia Strategies for Cardiac Surgery: A Literature Review. Hearts 5(3): 349-364.
11. Smith S, Sarier K, Yeom R, Choe I (2023) Regional Anesthesia for Cardiac Surgery. In: Martinez Hurtado ED, de Luis Cabezón N, Fernández-Vaquero MÁ, eds. Advances in Regional Anesthesia - Future Directions in the Use of Regional Anesthesia. IntechOpen.
12. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT (2018) 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 43(3): 263-309. doi:10.1097/aap.0000000000000763.
13. Sepolvere G, Marianello D, Santonocito C et al (2025) Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era? Journal of Clinical Medicine 14(3): 973.
14. Hong B, Oh C, Jo Y, Lee S, Park S, Kim YH (2022) Current evidence of ultrasound-guided fascial plane blocks for cardiac surgery: a narrative literature review. Korean J Anesthesiol 75(6): 460-472. doi: 10.4097/kja.22564.
15. Capuano P, Sepolvere G, Toscano A et al (2024) Fascial plane blocks for cardiothoracic surgery: A narrative review. J Anesth Analg Crit Care 4(1):20. doi:10.1186/s44158-024-00155-5.
16. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ (2016) The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med 41(5): 621-627. doi:10.1097/aap.0000000000000451.
17. Sharma V, Atluri H (2024) Comparison of Continuous Thoracic Epidural Analgesia Versus Bilateral Erector Spinae Plane Block for Pain Management in Coronary Bypass Surgery. Cureus 16(8): 67149. doi: 10.7759/cureus.67149.
18. Krishna SN, Chauhan S, Bhoi D et al (2019) Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 33(2): 368-375. doi: 10.1053/j.jvca.2018.05.050.
19. Blanco R (2011) The 'pecs block': a novel technique for providing analgesia after breast surgery. Anaesthesia 66(9): 847-848. doi:10.1111/j.1365-2044.2011.06838.x.
20. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim 59(9): 470-475. doi:10.1016/j.redar.2012.07.003.
21. Kumar KN, Kalyane RN, Singh NG et al (2018) Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery. Ann Card Anaesth. 21(3): 333-338. doi:10.4103/aca.ACA_15_18.
22. Magoon R, Kaushal B, Chauhan S, Bhoi D, Bisoi AK, Khan MA (2020) A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian J Anaesth 64(12): 1018-1024. doi: 10.4103/ija.IJA_566_20.
23. El Shora HA, El Beleehy AA, Abdelwahab AA et al (2020) Bilateral paravertebral block versus thoracic epidural analgesia for pain control post-cardiac surgery: A randomized controlled trial. Thorac Cardiovasc Surg 68(5): 410-416. doi:10.1055/s-0038-1668496.
24. Vandenbrande J, Jamaer B, Stessel B et al (2024) Serratus plane block versus standard of care for pain control after totally endoscopic aortic valve replacement: a double-blind, randomized controlled, superiority trial. Reg Anesth Pain Med 49(6): 429-435. doi:10.1136/rapm-2023-104439.
25. Aydin ME, Ahiskalioglu A, Ates I et al (2020) 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 34(11): 2996-3003. doi:10.1053/j.jvca.2020.06.044.
26. Kaya C, Dost B, Dokmeci O, Yucel SM, Karakaya D (2020) Comparison of Ultrasound-Guided Pecto-intercostal Fascial Block and Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind Pilot Study. J Cardiothorac Vasc Anesth 36(8 Pt A): 2313-2321. doi:10.1053/j.jvca.2021.09.041.
27. Zhang Y, Min J, Chen S (2022) Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial. Pain Med. 23(3): 440-447. doi: 10.1093/pm/pnab291.
28. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 68(11): 1107-1113. doi:10.1111/anae.12344.
29. Chin KJ, Versyck B, Pawa A (2021) Ultrasound-guided fascial plane blocks of the chest wall: A state-of-the-art review. Anaesthesia 76(1): 110-126. doi:10.1111/anae.15276.
30. Sertcakacilar G, Tire Y, Kelava M et al (2022) Regional anesthesia for thoracic surgery: A narrative review of indications and clinical considerations. J Thorac Dis 14(12): 5012-5028. doi:10.21037/jtd-22-599.
31. Walker JW, Cios TJ (2025) Local Anesthetic Choice for Regional Techniques in Cardiac Surgery: The Sauce Matters. J Cardiothorac Vasc Anesth 39(1): 8-12. doi:10.1053/j.jvca.2024.10.029.
32. Kirksey MA, Haskins SC, Cheng J, Liu SS (2015) Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 10(9): 0137312. doi:10.1371/journal.pone.0137312.
33. Chin KJ (2019) Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence. Best Pract Res Clin Anaesthesiol 33(1): 67-77. doi:10.1016/j.bpa.2019.02.003.
34. Song K, Xu Q, Knott VH et al (2021) Liposomal Bupivacaine-Based Erector Spinae Block for Cardiac Surgery. J Cardiothorac Vasc Anesth 35(5): 1555-1559. doi:10.1053/j.jvca.2020.09.115.
35. El-Boghdadly K, Pawa A, Chin KJ (2018) Local anesthetic systemic toxicity: Current perspectives. Local Reg Anesth 11: 35-44. doi:10.2147/lra.S154512.
Article Sidebar
Đã đăng
Aug 18, 2025
Số tạp chí
Chuyên mục
Articles
Trích dẫn bài viết này
Lâm V. T. (2025). Ứng dụng của gây tê vùng trong kiểm soát đau sau phẫu thuật tim với tuần hoàn ngoài cơ thể. Journal of 108 - Clinical Medicine and Phamarcy, 20(5). https://doi.org/10.52389/ydls.v20i5.2740