Application of preemptive parasternal intercostal nerve block in patients undergoing off pump coronary artery bypass grafting:A Double-Blind,Randomised, Controlled Trial

Abstract

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).