• Qi Li, Yi Liao, Xiaoe Wang, Mingying Zhan, Li Xiao, and Yu Chen.
• Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: liqi56@mail3.sysu.edu.cn.
• J Clin Anesth. 2024 Aug 1; 95: 111430111430.

Study ObjectiveThis study investigated whether catheter superficial parasternal intercostal plane (SPIP) blocks, using a programmed intermittent bolus (PIB) with ropivacaine, could reduce opioid consumption while delivering enhanced analgesia for a period exceeding 48 h following cardiac surgery involving sternotomy.DesignA double-blind, prospective, randomized, placebo-controlled trial.SettingUniversity-affiliated tertiary care hospital.Patients60 patients aged 18 or older, scheduled for cardiac surgery via sternotomy.InterventionsThe patients were randomly assigned in a 1:1 ratio to either the ropivacaine or saline group. After surgery, patients received bilateral SPIP blocks for 48 h with 0.4% ropivacaine (20 mL per side) for induction, followed by bilateral SPIP catheters using PIB with 0.2% ropivacaine (8 mL/side, interspersed with a 2-h interval) or 0.9% normal saline following the same administration schedule. All patients were administered patient-controlled analgesia with hydromorphone.MeasurementsThe primary outcome was the cumulative morphine equivalent consumption during the initial 48 h after the surgery. Secondary outcomes included postoperative pain assessment using the Numeric Rating Scale (NRS) at rest and during coughing at designated intervals for three days post-extubation. Furthermore, recovery indicators and ropivacaine plasma levels were diligently documented.Main ResultsCumulative morphine consumption within 48 h in ropivacaine group decreased significantly compared to saline group (25.34 ± 31.1 mg vs 76.28 ± 77.2 mg, respectively; 95% CI, -81.9 to -20.0, P = 0.002). The ropivacaine group also reported lower NRS scores at all recorded time points (P < 0.05) and a lower incidence of nausea and vomiting than the saline group (3/29 vs 12/29, respectively; P = 0.007). Additionally, the ropivacaine group showed significant improvements in ambulation (P = 0.018), respiratory exercises (P = 0.006), and self-reported analgesia satisfaction compared to the saline group (P = 0.016).ConclusionsBilateral catheter SPIP blocks using PIB with ropivacaine reduced opioid consumption over 48 h, concurrently delivering superior postoperative analgesia in adult cardiac surgery with sternotomy.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

44 keywords...

hide…