• Henry M K Wong, P Y Chen, Geoffrey C C Tang, Sandra L C Chiu, Louis Y H Mok, Sylvia S W Au, and WongRandolph H LRHLDivision of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong, China..
• Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China. Electronic address: henrymkwong@cuhk.edu.hk.
• J. Cardiothorac. Vasc. Anesth. 2024 Mar 1; 38 (3): 683690683-690.

ObjectivesSternotomy pain is common after cardiac surgery. The deep parasternal intercostal plane (DPIP) block is a novel technique that provides analgesia to the anterior chest wall. The aim of this study was to investigate the analgesic effect of bilateral DPIP blocks on intraoperative pain control in cardiac surgery.DesignThis is a double-blinded, prospective randomized controlled trial (Oct 2020-Dec 2022).SettingsThis study was conducted in a single institution, which is an academic university hospital.ParticipantsEighty-six elective cardiac surgical patients with median sternotomy were recruited.InterventionsPatients were randomly divided into DPIP or control group. Either 20ml 0.25% levobupivacaine or 0.9% normal saline was injected for the DPIP under ultrasound guidance after induction of general anaesthesia.Measurements And Main ResultsThe primary outcome was intraoperative opioids consumption and hemodynamic changes at sternotomy. Secondary outcomes included postoperative morphine consumption, postoperative pain and time to tracheal extubation. Intraoperative opioids requirement was reduced from a median (IQR) intravenous morphine equivalence of 21.4mg (13.8-24.3mg) in control group to 9.5mg (7.3-11.2mg) in the DPIP group (P<0.001). Hemodynamic parameters were more stable in DPIP group at sternotomy, as evidenced by lower percentage increase in systolic, diastolic and mean arterial blood pressure from baseline. No difference was observed in time to tracheal extubation, postoperative morphine consumption, postoperative pain score and spirometry.ConclusionsBilateral DPIP block provides effective intraoperative analgesia and opioid-sparing. It may be included as part of the multimodal analgesia for enhanced recovery in cardiac surgery.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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