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Intermittent Bolus versus Continuous Infusion Erector Spinae Catheters for Median Sternotomy Incisions:A Randomized
Patrick B Forrest1, Carlos E Guerra-Londono1, Katherine Nowak1
1Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, MI.
Journal of Cardiothoracic and Vascular Anesthesia
|July 8, 2026
Summary
Programmed intermittent boluses (PIB) via erector spinae plane (ESP) catheters did not reduce opioid use more than continuous infusion in open heart surgery patients. This study found no significant difference in pain management or recovery between the two ESP analgesia methods.
Area of Science:
- Anesthesiology
- Pain Management
- Thoracic Surgery
Background:
- Erector spinae plane (ESP) catheters are used for postoperative pain control.
- Programmed intermittent boluses (PIB) and continuous infusion are two methods for delivering analgesia via ESP catheters.
- Optimizing analgesia after open heart surgery is crucial for patient recovery.
Purpose of the Study:
- To compare the analgesic efficacy of PIB versus continuous infusion of ropivacaine via ESP catheters in adult patients undergoing open heart surgery.
- To determine if PIB offers superior pain relief and reduced opioid consumption compared to continuous infusion.
Main Methods:
- A prospective, randomized, double-blind trial involving 240 adult patients undergoing open heart surgery.
- Participants received either continuous infusion or PIB of 0.2% ropivacaine via bilateral ESP catheters.
- The primary outcome was postoperative opioid consumption (oral morphine milligram equivalents - OMME) over 72 hours.
Main Results:
- No statistically significant difference in total opioid consumption (OMME) between the PIB and continuous infusion groups (p = 0.40).
- The PIB group showed a non-significant trend towards higher opioid consumption.
- Secondary outcomes, including pain intensity, length of stay, and quality of recovery, were similar between groups.
Conclusions:
- Programmed intermittent boluses (PIB) via ESP catheters did not significantly reduce early postoperative opioid consumption compared to continuous infusion in open heart surgery.
- ESP catheter-based analgesia with either method did not demonstrate a significant advantage for opioid-sparing or pain management in this patient population.
