Journal Article

Efficacy of bilateral catheter superficial parasternal intercostal plane blocks using programmed intermittent bolus for opioid-sparing postoperative analgesia in cardiac surgery with sternotomy: A randomized, double-blind, placebo-controlled trial

Liao, Yi, Zhan, Mingying, Wang, Xiaoe, Xiao, Li, Chen, Yu, Li, Qi

2024

Overview

This study investigated whether catheter superficial parasternal intercostal plane (SPIP) blocks, using a programmed intermittent bolus (PIB) with ropivacaine, could reduce opioid consumption while delivering enhanced analgesia for a period exceeding 48 h following cardiac surgery involving sternotomy. A double-blind, prospective, randomized, placebo-controlled trial. University-affiliated tertiary care hospital. 60 patients aged 18 or older, scheduled for cardiac surgery via sternotomy. The patients were randomly assigned in a 1:1 ratio to either the ropivacaine or saline group. After surgery, patients received bilateral SPIP blocks for 48 h with 0.4% ropivacaine (20 mL per side) for induction, followed by bilateral SPIP catheters using PIB with 0.2% ropivacaine (8 mL/side, interspersed with a 2-h interval) or 0.9% normal saline following the same administration schedule. All patients were administered patient-controlled analgesia with hydromorphone. The primary outcome was the cumulative morphine equivalent consumption during the initial 48 h after the surgery. Secondary outcomes included postoperative pain assessment using the Numeric Rating Scale (NRS) at rest and during coughing at designated intervals for three days post-extubation. Furthermore, recovery indicators and ropivacaine plasma levels were diligently documented. Cumulative morphine consumption within 48 h in ropivacaine group decreased significantly compared to saline group (25.34 ± 31.1 mg vs 76.28 ± 77.2 mg, respectively; 95% CI, −81.9 to −20.0, P = 0.002). The ropivacaine group also reported lower NRS scores at all recorded time points (P < 0.05) and a lower incidence of nausea and vomiting than the saline group (3/29 vs 12/29, respectively; P = 0.007). Additionally, the ropivacaine group showed significant improvements in ambulation (P = 0.018), respiratory exercises (P = 0.006), and self-reported analgesia satisfaction compared to the saline group (P = 0.016). Bilateral catheter SPIP blocks using PIB with ropivacaine reduced opioid consumption over 48 h, concurrently delivering superior postoperative analgesia in adult cardiac surgery with sternotomy. •Postoperative pain after cardiac surgery is challenging.•Catheter superficial parasternal intercostal plane blocks using a programmed intermittent bolus regimen reduced the morphine equivalent requirement up to three days after surgery.•The technique also reduces the incidence of postoperative nausea and vomiting, facilitating postoperative recovery.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Amides - administration & dosage / Analgesia, Patient-Controlled - methods / Analgesics, Opioid - administration & dosage / Anesthesia / Anesthetics, Local - administration & dosage / Cardiac surgery / Cardiac Surgical Procedures - adverse effects / Cardiac Surgical Procedures - methods / Catheters / Chronic pain / Double-Blind Method / Epidural / Extubation / Female / General anesthesia / Heart surgery / Hemodynamics / Humans / Hydromorphone - administration & dosage / Intercostal Nerves - drug effects / Male / Middle Aged / Morphine - administration & dosage / Narcotics / Nausea / Nerve Block - methods / Opioid-sparing analgesia / Pain management / Pain Measurement / Pain Medicine / Pain, Postoperative - diagnosis / Pain, Postoperative - etiology / Pain, Postoperative - prevention & control / Patients / Placebo effect / Postoperative pain / Postoperative period / Programmed intermittent bolus / Prospective Studies / Quality of life / Recovery (Medical) / Ropivacaine - administration & dosage / Side effects / Sternotomy - adverse effects / Superficial parasternal intercostal plane block catheters / Treatment Outcome