A Prospective, Randomized, Blinded Study of Continuous Ropivacaine Infusion in the Median Sternotomy Incision Following Cardiac Surgery

Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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“…[126][127][128][129][130][131][132][133] No evidence regarding their effect on the development of chronic pain exists. 126 …”

Section: Continuous Wound Cathetermentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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“…One study [17] of minimal invasive hip replacement reported no delays in wound healing and no wound infections at the 3-month follow-up visit. During the preparation of the manuscript, the previously unpublished sternotomy study suspended due to an increased wound infection rate [18] was published; this study by Agarwal et al [27] reported wound infection rates of 9.1% (4/44) for ropivacaine and 0% (0/41) for placebo. While the ropivacaine rate was not statistically different from placebo, it was significantly higher than the clinic's historical control rate and therefore resulted in premature discontinuation of the study.…”

Section: Resultsmentioning

confidence: 99%

Ropivacaine for Continuous Wound Infusion for Postoperative Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2014

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Background: The use of continuous wound infusion (CWI) of local anaesthetics has been suggested as a safe and effective alternative technique to epidural anaesthesia/analgesia that allows surgeons to provide postoperative pain relief while reducing opioid consumption and associated adverse events. A previous meta-analysis by Liu et al. [Am Coll Surg 2006;203:914-932] reported results mainly from studies of bupivacaine. Subsequently, several new randomized controlled trials (RCTs) of ropivacaine have been published. This systematic review and quantitative meta-analysis evaluates the efficacy of ropivacaine for CWI. Methods: Systematic literature searches (EMBASE, MEDLINE) were performed to retrieve studies which met the following criteria: double-blind RCT of ropivacaine versus either placebo or an active comparator; use of ropivacaine solution without added active agents, and prohibition of other routine analgesics during the study period except rescue patient-controlled analgesia. For each included study, standardized effect sizes for ropivacaine versus placebo were calculated for opioid rescue use, pain score at rest, and pain score at mobilization. Meta-analyses were conducted for each endpoint. Results: Fourteen RCTs comparing ropivacaine (n = 376) versus placebo (n = 380) were identified. Effect size estimates revealed significantly less opioid rescue use for ropivacaine patients (-1.3; 95% CI -1.5 to -1.1) and significantly less pain for ropivacaine patients both at rest (-1.1; 95% CI -1.3 to -0.9) and on mobilization (-1.5; 95% CI -1.7 to -1.3). The weighted mean reduction in opioid rescue use was 22.4 mg. Conclusion: This systematic review and meta-analysis presents substantial evidence that ropivacaine provides clinically meaningful reductions in opioid use and pain outcomes. Ropivacaine CWI is effective for postoperative pain management in a wide range of surgical procedures.

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“…It was also reported that the incidence of catheter or pump failure was 1.1 %. Although it has been reported that the local anesthetic ropivacaine displays antimicrobial activity [15], a study of continuous ropivacaine infusion in the median sternotomy incision following cardiac surgery showed high infection rates (9 %, n = 44) and this rate of infection was not statistically different in the saline group (0 %, n = 41) (P [ 0.05) [16]. However, a larger sample size must be evaluated before a definitive conclusion can be drawn about the safety of this technique.…”

Section: Discussionmentioning

confidence: 99%

Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial

Ren

et al. 2015

Eur Spine J

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Purpose A prospective randomized clinical trial was carried out to observe the analgesic efficacy of ropivacaine for postoperative pain following thoracolumbar spinal surgery. Methods Seventy-one patients with elective posterior thoracolumbar spinal surgery were randomly divided into two groups. Local group received 0.33 % ropivacaine by pump through the wound, and intravenous group received flurbiprofen axetil, pentazocine and palonosetron via intravenous pump. We evaluated the level of pain, the incidence of adverse reactions at 2, 4, 6, 12, 24, 36 and 48 h after operation, and the occurrence of chronic pain 3 months later. Results There were no significant differences in the pain level between the two groups. However, the incidence of nausea, vomiting and chronic pain was significantly lower in the local group. Conclusions Our results showed that local infusion of ropivacaine achieved similar analgesic effects to intravenous delivery of analgesic drugs, but significantly reduced incidence of nausea, vomiting and chronic pain.

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A Prospective, Randomized, Blinded Study of Continuous Ropivacaine Infusion in the Median Sternotomy Incision Following Cardiac Surgery

Abstract: The phase III trial did not show improvement in time to extubation of the trachea or pain control in the 0.3% ropivacaine group, but it was stopped early by the data safety monitoring board.

Cited by 49 publications

References 34 publications

Chronic Poststernotomy Pain

Chronic Poststernotomy Pain

Ropivacaine for Continuous Wound Infusion for Postoperative Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial

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