{
  "abstract": "Background and Aims Regional anaesthesia (RA) for cardiac surgery (CS) involving sternotomy remains underutilized, despite increasing evidence supporting its effectiveness for pain management. While various RA techniques are continually reviewed and refined, adoption in clinical practice varies. This study aimed to evaluate global anaesthetists’ preferences for RA techniques and explore perceived barriers limiting RA use in CS.Methods An anonymized survey was distributed to 290 anaesthetists across 59 countries via mailing lists from anaesthesia societies including ESRA, ACTACC, and EBPOM. The survey assessed RA practices for sternotomy pain and factors influencing their use.Results Among respondents, 41% specialized in cardiothoracic anaesthesia. Only 33% reported an ERAS program that includes CS at their institution; 19% had ERAS protocols excluding RA, and 48% had no ERAS protocol at all. Overall, 48% reported using RA for sternotomy cases, while 52% did not. Reported complications of RA in this context included haemodynamic instability (25%), haematoma (20%), local anaesthetic systemic toxicity (15%), arrhythmia (15%), block failure (5%), and pneumothorax (3%). Use of neuraxial techniques was rare: 7% used thoracic epidurals, 3% intrathecal opioids, and 90% did not use neuraxial approaches. The most commonly used RA techniques were: • Single-shot (SS) superficial parasternal block (24%) • SS deep parasternal/transversus thoracic muscle plane block (16.6%) • SS erector spinae plane (ESP) block (10%) • SS serratus plane block (9%) • SS PECS I/II block (8.7%) Other approaches included SS intercostal, rectus sheath blocks, and continuous catheter techniques (ESP, paravertebral, intercostal, serratus). Barriers to RA included time constraints (31%), patient anxiety/refusal (29%), and surgeon preference (18%). Other barriers included patient body habitus and limited drugs/equipment access.Conclusions This survey reveals global variability in RA practices for sternotomy highlighting key obstacles to broader implementation. Inconsistent ERAS integration, diverse technique preferences, and logistical/cultural barriers suggest opportunities for improvement through targeted education, protocol development, and institutional support.",
  "authors": [
    {
      "affiliations": [
        "Anaesthesia SpR, CHI at Temple Street Hospital, Dublin, Ireland, Rochfortbridge, Ireland"
      ],
      "name": "Frances Fallon"
    },
    {
      "affiliations": [
        "Anaesthesia SpR, Department of Anaesthesia Beaumont Hospital, Dublin, Ireland"
      ],
      "name": "Emma Garry"
    },
    {
      "affiliations": [
        "Anaesthesia SpR, Department of Anaesthesia University Hospital Limerick, Limerick, Ireland"
      ],
      "name": "Meghan Harbison"
    },
    {
      "affiliations": [
        "Consultant Anaesthesiologist, Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Catalin Iulian Efrimescu"
    }
  ],
  "title": "P213 International trends in regional anaesthesia for sternotomy surgery",
  "uid": "15ea0490-da69-5f34-aafe-0487118101f6"
}