BackgroundParasternal intercostal nerve block has been increasingly used for postoperative analgesia and has shown that this technique can provide effective postoperative analgesia. This study aimed to investigate the effect of preemptive parasternal intercostal nerve block on the opioid and vasoactive drug dose required for intraoperative hemodynamic stability and postoperative analgesia in patients undergoing off-pump coronary artery bypass grafting.MethodsIn this prospective, randomized controlled study, 64 participants aged 45–75 years scheduled for off-pump coronary artery bypass grafting at The Second Xiangya Hospital of Central South University. Patients were randomized into two groups and preoperatively administered ropivacaine (group R) and saline (group S), in the parasternal intercostal spaces with ultrasound-guided bilateral nerve block.ResultsThe primary outcome was intraoperative sufentanil and vasopressor dosage. The secondary outcomes were intraoperative hemodynamics, postoperative pain scores, and anesthesia recovery, postoperative use of rescue dezocine, stay in intensive care unit, and length of hospital stay. The consumption of intraoperative sufentanil and vasopressor was significantly lower in group R than in group S. The visual analog score in group R was significantly lower than that in group S up to 12 h postoperatively. The time to anesthesia recovery was significantly less in group R than in group S. Most patients in group S required rescue dezocine, whereas most patients in group R did not. The hemodynamic variables were stable in all patients.ConclusionsA preemptive parasternal intercostal nerve block effectively reduced the required intraoperative sufentanil and norepinephrine dose and provided adequate analgesia for the first 12 h after surgery. Therefore, a preemptive parasternal intercostal nerve block is a good option for patients undergoing off-pump coronary artery bypass grafting.Clinical trial registrationchictr.org.cn, identifier ChiCTR1800017210.

Background: Parasternal intercostal nerve block as superficial block has been increasingly used for postoperative analgesia via performed before sternal suture placement, and has shown that this technique can provide effective postoperative analgesia and facilitate rapid-recovery. However, the impact of preemptive parasternal intercostal nerve block has not been researched for cardiac surgery patients. Methods: Sixty-four patients underwent OPCABG were randomly divided into parasternal intercostal nerve block with ropivacaine ( n = 32) group and parasternal intercostal nerve block with saline ( n = 32) group. Before anaesthesia induction, 20ml of 0.35% Ropivacaine along with 1 mg dexamethasone or saline on each side, total dosage 40 ml, via parasternal intercostal injection. 5ml of 0.35% ropivacaine along with 0.5 mg dexamethasone or saline on each leg, total dosage 10 ml, via peripheral saphenous nerve block. Results: The consumptions of intraoperative sufentanil and vasopressor were significantly lower in ropivacaine group(P＜0.05). Analgesia was adequate in the ropivacaine group up to 20 h. VAS score in the ropivacaine group significantly was lower compared with the saline group up to 12 h postoperatively(P＜0.05). The time of first rescue analgesic, anaesthesia recovery and extubation were significantly less in patients of the ropivacaine group(P＜0.05). The majority of the ropivacaine group patients did not need rescue dezocine, while the most of the saline group needed dezocine (P <0.05). The hemodynamic variables were stable in all patients. Few cases reported trivial adverse effects. Conclusions: Preemptive parasternal intercostal nerve block provide adequate analgesia for the first 20 h after surgery and reduce intraoperative sufentanil, intraoperative norepinephrine and postoperative dezocine consumption as well as the time of extubation. Trial registration: The study was registered at chictr.org.cn (identifier: ChiCTR1800017210，Registered 18 July 2018).