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Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial.

Antti Kalli1,2, Julia Vistback3, Eeva Moilane3

  • 1Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|July 8, 2025
PubMed
Summary

Ultrasound-guided superficial parasternal intercostal plane block (SPIP) improves postoperative lung function after aortic valve surgery. SPIP also impacts inflammatory markers, specifically decreasing arterial chemerin and increasing the venous/arterial IL6 ratio.

Keywords:
SPIPaortic valve replacementinterleukin-6lung function

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Area of Science:

  • Anesthesiology
  • Thoracic Surgery
  • Pulmonology

Background:

  • Cardiac surgery, particularly via full sternotomy, is known to impair postoperative lung function.
  • The superficial parasternal intercostal plane block (SPIP) is a regional anesthesia technique that may mitigate these effects.

Purpose of the Study:

  • To investigate the impact of ultrasound-guided SPIP on postoperative lung function and inflammatory capacity following surgical aortic valve replacement (SAVR).
  • To assess changes in specific inflammatory markers (chemerin, YKL-40, resistin, IL-6) in relation to SPIP administration.

Main Methods:

  • A randomized controlled trial involving 74 patients undergoing SAVR, with 37 receiving SPIP and 37 serving as controls.
  • Preoperative and postoperative lung function tests (FEV, FVC) were compared between groups.
  • Venous and arterial blood samples were analyzed for inflammatory factors at three time points: before surgery, immediately after aortic cross-clamp release, and the morning after surgery.

Main Results:

  • Patients receiving SPIP showed significantly less decrease in forced expiratory volume in 1 second (FEV) and forced vital capacity (FVC).
  • While total oxycodone consumption, YKL-40, and resistin levels did not differ, arterial chemerin levels decreased in the SPIP group.
  • The venous/arterial IL-6 ratio increased in patients with SPIP compared to controls.

Conclusions:

  • Ultrasound-guided SPIP before SAVR via full sternotomy positively impacts postoperative respiratory function.
  • SPIP influences the postoperative inflammatory response, as evidenced by changes in arterial chemerin and the venous/arterial IL-6 ratio.