Efficacy of Surgeon-Administered Regional Anesthesia in Cardiac Surgery: A Double-Blinded, 2-Center, Randomized,...

Managing pain after median sternotomy is a clinical challenge of balancing adequate pain relief with avoidance of excessive opioid consumption. While regional anesthesia techniques are increasingly recommended and applied in cardiac surgery, evidence of sustained postoperative benefit remains limited and heterogeneous. The authors aimed to evaluate the efficacy and safety of long-acting regional infiltration anesthesia in patients undergoing coronary artery bypass grafting.

The trial was conducted as a double-blinded, placebo-controlled trial in which participants were randomized 1:1 to intervention or placebo.

Cardiothoracic departments at 2 Danish university hospitals.

Patients undergoing non-emergent coronary artery bypass grafting.

Participants were allocated to receive surgeon-administered intraoperative infiltration of the sternum and chest wall with either 62.5 mL of bupivacaine with epinephrine, clonidine, and dexamethasone or an equivalent volume of isotonic saline solution as placebo.

The primary endpoint was total opioid consumption within the first 24 postoperative hours. Secondary endpoints included patient-reported postoperative pain, as well as measures of recovery, respiratory impact, and chronic opioid use. A total of 113 patients were randomized, with 100 patients completing the trial and being included in the final analysis. No difference in opioid consumption was observed between the two groups. The median oral morphine equivalents were 62.3 mg (interquartile range, 70.8 mg) in the active intervention group and 64.0 mg (interquartile range, 46.8 mg) in the placebo group (p = 0.649). None of the secondary or safety endpoints showed significant differences.

In this double-blind, randomized trial, surgeon-administered regional anesthesia did not reduce opioid consumption or provide additional clinical benefits following median sternotomy.