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OP63 Finding the sweet spot: optimising parasternal block volume at 0.125% bupivacaine for enhanced post cardiac surgery analgesia
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OP63 Finding the sweet spot: optimising parasternal block volume at 0.125% bupivacaine for enhanced post cardiac surgery analgesia
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Journal Article
OP63 Finding the sweet spot: optimising parasternal block volume at 0.125% bupivacaine for enhanced post cardiac surgery analgesia
2025
Overview
Background and AimsIntense post sternotomy pain delays mobilisation and increases peri operative opioid exposure. Ultrasound guided bilateral parasternal block provides targeted anterior chest wall analgesia; however, the dose-volume relationship of local anaesthetic for this block remains undefined. After establishing that 0.125% bupivacaine is clinically effective, we conducted a randomised controlled trial to evaluate whether varying injectate volumes at this fixed concentration modulate analgesic efficacy and opioid consumption.MethodsThis prospective, randomised, single-blind trial enrolled 44 adults for elective median sternotomy. After ethics approval (Pauls Stradiņš Clinical University Hospital, 281123–11L), patients received a bilateral parasternal block with 0.125% bupivacaine: 20 ml (n = 12), 40 ml (n = 20) or 60 ml (n = 12). Pain intensity (Numerical Rating Scale, NRS 0–10) was measured at 0, 4, 8, 12, 20 and 24 h. Secondary endpoints were 24-h opioid use and time-to-rescue analgesia.ResultsMedian NRS at 12 hours postoperatively was 1 (IQR 0–3) after 20 ml, 1 (IQR 0–3) after 40 ml and 1 (IQR 0–2) after 60 ml (p = 0.801); pain scores did not differ significantly at any measured time point (p >0.05). Time to rescue was markedly shorter with 20 ml – median 120 min (IQR 120–300)—versus 40 ml – 995 min (IQR 440–1275) and 60 ml – 420 min (IQR 218–450); Repeated rescue opioid was needed in 25% of patients who received 20 ml, whereas none required it after 40 ml or 60 ml (p = 0.012).ConclusionsInjectate volume was decisive≥ 40 ml abolished rescue-opioid use; 40 ml produced the longest opioid-free period with no safety issues, whereas 60 ml offered no added benefit. Thus, a 40 ml bilateral parasternal block with 0.125% bupivacaine is the volume-efficacy sweet spot for post-sternotomy analgesia. Larger multicentre trials should validate these findings and refine practice.
Publisher
BMJ Publishing Group LTD
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