Efficacy of parasternal block to decrease intraoperative opioid use in coronary artery bypass surgery via sternotomy:...

Area of Science:

• Anesthesiology
• Cardiac Surgery
• Pain Management

Background:

• Coronary artery bypass graft (CABG) surgery requires careful hemodynamic management.
• Opioid and anesthetic consumption during sternotomy can impact patient outcomes.
• Minimally invasive techniques are sought to reduce intraoperative drug requirements.

Purpose of the Study:

• To evaluate the efficacy of a preoperative parasternal plane block (PSB) in reducing opioid consumption during sternotomy for CABG.
• To assess the impact of PSB on the requirement for anesthetics like remifentanil and propofol.
• To investigate the effect of PSB on postoperative inflammatory markers.

Main Methods:

• A double-blind, randomized, placebo-controlled trial was conducted with 35 patients undergoing CABG.
• Patients received either a preoperative PSB with ropivacaine or a saline placebo.
• The primary endpoint was the maximal effect-site concentration of remifentanil needed to maintain hemodynamic stability during sternotomy.

Main Results:

• The PSB group required significantly less remifentanil (median 4.2 ng/mL) compared to the placebo group (median 7.0 ng/mL) (p=0.02).
• Propofol consumption was also reduced in the PSB group (mean 3.9 µg/mL vs 5.0 µg/mL, p=0.02).
• PSB led to better sedation levels and reduced postoperative levels of inflammatory cytokines (IL-8, IL-18, IL-23, IL-33, MCP-1).

Conclusions:

• Preoperative PSB is effective in reducing intraoperative opioid and anesthetic requirements during sternotomy for CABG.
• PSB improves hemodynamic stability and depth of anesthesia control.
• This technique may mitigate the postoperative inflammatory response in cardiac surgery patients.