Ultrasound-Guided Superficial Parasternal Intercostal Plane Block for Early Pain Management in Patients Undergoing...

Sternotomy causes substantial postoperative pain. Recently, several less invasive nerve blocks have been described that are safer to use even on anticoagulated patients. This study aims to evaluate early pain management using ultrasound-guided superficial parasternal intercostal plane block (SPIP) in patients undergoing aortic valve replacement via full sternotomy.

This was a randomized, placebo-controlled trial performed in a tertiary referral hospital. Seventy-four elective patients scheduled for aortic valve replacement via full sternotomy were included. Patients were randomized to receive a preoperative SPIP block using either 40 mL of ropivacaine 7.5 mg/mL or 40 mL of 0.9% saline. Cumulative oxycodone consumption during the first 24 postoperative hours was recorded and analyzed as the primary outcome. Pain at rest was assessed using the numerical rating scale (NRS) scores 48 h postoperatively. Additional secondary outcomes included the need for vasopressors and antiemetics, recovery of bowel function, time spent in the intensive care unit (ICU), and nerve block-related complications.

The 24-h cumulative consumption was not significantly different between groups (93.8 mg ± 33.3 vs. 109.4 mg ± 37.9, p = 0.066). NRS pain scores at rest were reduced in the patients with SPIP at 4 (5.0 ± 1.8 vs. 3.3 ± 2.4, p = 0.002). No differences were found in additional secondary outcomes.

In this randomized controlled trial a single-shot SPIP block did not reduce the 24-h cumulative opioid consumption after cardiac surgery.

This trial in a cardiac surgical cohort tested for possible benefit of a single injection superficial parasternal intercostal plane block for post-operative analgesia for post-sternotomy pain. The study found no post-op opioid treatment reduction with the treatment, but some analgesia effect cannot be ruled out.