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Perioperative Pain Management in Patients with Congenital Heart Disease

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Congenital Heart Disease in Pediatric and Adult Patients

Abstract

The care of children with congenital heart disease is complex. In addition to considering intricate intracardiac anatomy, these children present with secondary issues that are either a result of their intracardiac pathology (liver failure from a failed Fontan palliation) or the management of this pathology. Persistent pain after sternotomy or thoracotomy is an underappreciated result of the latter. The little evidence available demonstrates that post-sternotomy pain may be 20 % 4 years after surgery in children, and post-thoracotomy pain between 1.96 and 16 %. There are distinct pathophysiologic mechanisms that distinguish this pain from acute postoperative pain, and proper management requires recognition and possible referral to a multidisciplinary pain clinic.

As with chronic postoperative pain after cardiothoracic surgery, the use of regional anesthetic techniques is underappreciated in patients with congenital heart disease. With the use of ultrasound, these nerve blocks are safe and particularly useful in those children that may not tolerate general anesthesia. Neuraxial blocks, paravertebral nerve blocks, Pecs and serratus plane blocks, as well as transversus abdominis plane blocks are a group of peripheral blocks that can be used for a variety of thoracic, abdominal, and lower extremity procedures in pediatric patients with congenital heart disease presenting for noncardiac surgery.

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  1. Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin Street, Suite A3300, Houston, TX, 77030, USA

    Evelyn C. Monico MD & Zoel Augusto Quiñónez MD

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  1. Evelyn C. Monico MD
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  2. Zoel Augusto Quiñónez MD
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Correspondence to Evelyn C. Monico MD .

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  1. Cardiac Anesthesiology Department, Anesthesiology Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ali Dabbagh

  2. Kaiser Permanente Los Angeles Medical Center Division of Cardiac Anesthesiology, Los Angeles, California, USA

    Antonio Hernandez Conte

  3. Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Lorraine Lubin

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Monico, E.C., Quiñónez, Z.A. (2017). Perioperative Pain Management in Patients with Congenital Heart Disease. In: Dabbagh, A., Conte, A., Lubin, L. (eds) Congenital Heart Disease in Pediatric and Adult Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-44691-2_39

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