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

To determine if deep parasternal intercostal plane (DPIP) blocks are associated with reduced opioid consumption and a subsequent reduction in postoperative delirium after cardiac surgery.

A retrospective observational study.

A single-center tertiary care hospital.

Three hundred and eight adult patients who underwent cardiac surgery with median sternotomy between March 2021 and February 2023.

DPIP blocks are performed after chest closure in the operating room under sterile conditions and with real-time ultrasound guidance. The control group did not receive DPIP blocks.

Median [range] postoperative hydromorphone consumption at 12 hours was 0.8 [0-2.6] mg vs. 1.2 [0-2.6] mg, p = 0.0004, and at 24 hours was 0.4 [0-3.2] mg versus 0.6 [0-3.4] mg, p = 0.007 in the DPIP and control groups, respectively. Predictors of reduced hydromorphone requirements included the presence of DPIP blocks, use of a dexmedetomidine infusion, and absence of composite comorbidities. Postoperative delirium was present in 17 (11%) and 23 (14.9%) patients in the DPIP block and control groups respectively (odds ratio 0.76; 95% confidence interval 0.38-1.53, p = 0.45). The median [IQR] time to extubation was 135 [65, 274] minutes versus 196.5 [74, 420] minutes in the DPIP and control groups, respectively, p = 0.04. There was no difference with respect to major morbidity and mortality between the two groups.

DPIP blocks were associated with decreased perioperative opioid consumption, and earlier tracheal extubation after cardiac surgery. DPIP blocks may be incorporated within the fast-track cardiac anesthesia pathways; however, alternative strategies need to be further explored to reduce postoperative delirium after cardiac surgery.