Deep Parasternal Intercostal Plane Blocks and Their Role in a Cardiac Fast-Track Program

Area of Science:

• Anesthesiology and Critical Care Medicine
• Thoracic Surgery
• Pain Management

Background:

• Postoperative pain management after cardiac surgery often relies on opioids, which can lead to adverse effects like delirium.
• Deep parasternal intercostal plane (DPIP) blocks offer a regional anesthesia approach that may mitigate opioid-related complications.

Purpose of the Study:

• To evaluate the association between DPIP blocks and reduced opioid consumption post-cardiac surgery.
• To assess the impact of DPIP blocks on the incidence of postoperative delirium.

Main Methods:

• A retrospective observational study involving 308 adult patients undergoing cardiac surgery with median sternotomy.
• Patients received either DPIP blocks under ultrasound guidance or standard care (control group).
• Opioid consumption, delirium incidence, and time to extubation were compared between groups.

Main Results:

• DPIP blocks were associated with significantly lower hydromorphone consumption at 12 and 24 hours postoperatively.
• Patients receiving DPIP blocks experienced earlier tracheal extubation (p=0.04).
• No significant difference in postoperative delirium incidence or major morbidity/mortality was observed between groups.

Conclusions:

• DPIP blocks are linked to decreased perioperative opioid requirements and faster extubation following cardiac surgery.
• DPIP blocks show potential for integration into fast-track cardiac anesthesia protocols.
• Alternative strategies are necessary to effectively reduce postoperative delirium in this patient population.