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

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.