Continuous Ropivacaine Infusion Offers No Benefit in Treating Postoperative Pain After Cardiac Surgery

Area of Science:

• Anesthesiology
• Cardiothoracic Surgery
• Pain Management

Background:

• Multimodal pain management is crucial after cardiac surgery to reduce opioid dependence.
• Continuous local anesthetic infusion into median sternotomy wounds is a proposed method, but its effectiveness remains debated due to conflicting study results.

Purpose of the Study:

• To evaluate the efficacy of continuous 0.2% ropivacaine wound infusion in reducing postoperative opioid consumption and pain after cardiac surgery.
• To determine if this method offers a beneficial approach to post-sternotomy pain management.

Main Methods:

• A prospective, randomized, double-blinded, placebo-controlled trial was conducted with 90 patients undergoing coronary artery bypass grafting or heart valve surgery.
• Patients received either continuous 0.2% ropivacaine or placebo infusion into the sternotomy wound for 48 hours postoperatively.
• Pain was assessed using the visual analogue scale, and total oxycodone consumption was recorded.

Main Results:

• There were no significant differences in cumulative oxycodone consumption between the ropivacaine (97 ± 27 mg) and placebo (96 ± 29 mg) groups (p=0.813).
• Pain scores at rest and during deep breathing were similar in both groups.
• Incidences of adverse events and surgical wound infections were comparable between the ropivacaine and placebo groups.

Conclusions:

• Continuous 0.2% ropivacaine infusion into the median sternotomy wound did not effectively reduce postoperative pain or opioid consumption in the first 48 hours after cardiac surgery.
• The findings suggest that this technique is not beneficial for managing post-sternotomy pain.