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Deep Parasternal Intercostal Plane Block for Intraoperative Pain Control in Cardiac Surgical Patients for Sternotomy:
Henry M K Wong1, P Y Chen1, Geoffrey C C Tang1
1Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China.
Journal of Cardiothoracic and Vascular Anesthesia
|December 26, 2023
Summary
Bilateral deep parasternal intercostal plane (DPIP) blocks significantly reduced intraoperative opioid use and improved hemodynamic stability in cardiac surgery patients. This novel technique offers effective analgesia for enhanced recovery.
Area of Science:
- Anesthesiology
- Pain Management
- Thoracic Surgery
Background:
- Sternotomy pain is a significant challenge following cardiac surgery.
- The deep parasternal intercostal plane (DPIP) block is an emerging technique for anterior chest wall analgesia.
Purpose of the Study:
- To evaluate the efficacy of bilateral DPIP blocks in controlling intraoperative pain during cardiac surgery.
- To assess the impact of DPIP blocks on opioid consumption and hemodynamic parameters.
Main Methods:
- A double-blinded, prospective randomized controlled trial involving 86 elective cardiac surgery patients.
- Patients received either a bilateral DPIP block with levobupivacaine or a control (saline) under ultrasound guidance.
- Intraoperative opioid consumption and hemodynamic changes were primary outcomes.
Main Results:
- The DPIP group showed a significant reduction in intraoperative opioid requirements (median 9.5mg vs. 21.4mg morphine equivalent).
- Hemodynamic parameters, including blood pressure, were more stable in the DPIP group during sternotomy.
- No significant differences were found in postoperative outcomes like pain scores or extubation time.
Conclusions:
- Bilateral DPIP blocks provide effective intraoperative analgesia and reduce opioid requirements in cardiac surgery.
- This technique can be a valuable component of multimodal analgesia strategies for enhanced recovery after sternotomy.
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