Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?

Pala, Arda Aybars; Urcun, Yusuf Salim; Çiçek, Ömer Faruk; ŞAHİN, Serpil

doi:10.7759/cureus.10711

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…Pharmacological techniques, such as opioids and anti-inflammatory drugs, infiltration with local anesthetics, nerve blocks, and spinal analgesia 12 , and non-pharmacological techniques, such as heat/cold application, massage, hypnosis, and distraction techniques, exist. Continuous infusion of local anesthetics can reduce the intensity of acute postoperative pain, opioid use, mechanical ventilation time, hospital stay, and atelectasis, and it is a simple and effective method for treating pain after median sternotomy 23 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study

Viana

Oliveira

et al. 2023

Rev. Assoc. Med. Bras.

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OBJECTIVE: This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. METHODS: A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. RESULTS: Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. CONCLUSION: Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.

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Section: Discussionmentioning

confidence: 99%

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study

Viana

Oliveira

et al. 2023

Rev. Assoc. Med. Bras.

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“…When combined with high heterogeneity, this may bias the results of a random-effects meta-analysis by over-emphasizing the contributions of smaller studies with higher observed effect sizes. Abassi et al 13 NA NA Agarwal et al 14 4/44 0/41 29 NA NA…”

Section: Limitationsmentioning

confidence: 99%

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

King

Stambulic

Hassan

et al. 2022

Journal of Cardiac Surgery

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Background Inadequate pain control after median sternotomy leads to reduced mobilization, increased respiratory complications, and longer hospital stays. Typically, postoperative pain is controlled by opioid analgesics that may have several adverse effects. Parasternal intercostal block (PSB) has emerged as part of a multimodal strategy to control pain after median sternotomy. However, the effectiveness of this intervention on postoperative pain control and analgesic use has not been fully established. Methods and Results We conducted a meta‐analysis to assess the effect of PSB on postoperative pain and analgesic use in adult cardiac surgery patients undergoing median sternotomy. PubMed, Embase, Google Scholar, and the Cochrane database were searched with the following search strategy: ([postoperative pain] or [pain relief] OR [analgesics] or [analgesia] or [nerve block] or [regional block] or [local block] or [regional anesthesia] or [local anesthetic] or [parasternal block] and [sternotomy]) and (humans [filter]). Inclusion criteria were: patients who underwent cardiac surgery via median sternotomy, age >18 and parasternal block (continuous and single dose). Exclusion criteria were: noncardiac surgery, nonparasternal nerve blocks, and the use of NSAIDS in parasternal block. Quality assessment was performed by three independent reviewers via the Cochrane risk of bias assessment tool. Of 1165 total citations, 18 were found to be relevant. Of these 18 citations, 7 citations (N = 2223 patients) reported postoperative pain scores in an extractable format and 11 citations (N = 2155 patients) reported postoperative opioid use in an extractable format. For postoperative opioid use, morphine equivalent doses were calculated for all studies and postoperative pain scores were standardized to a 10‐point visual analog scale for comparison between studies; both these were reported as total opioid use or cumulative score ranging from 24 to 72 h postoperative. All data analyses were run using a random effects model, using a restricted maximum likelihood estimator, to obtain summary standardized mean differences with 95% confidence interval (CI's). For studies which only reported median and interquatile range (IQR), the median was standard deviation was estimated by IQR/1.35. Following median sternotomy both postoperative pain (SMD [95% CI] −0.49 [−0.92 to −0.06]) and postoperative morphine equivalent use (SMD [95% CI] −1.68 [−3.11 to −0.25]) were significantly less in the PSB group. Conclusion Our meta‐analysis suggests that parasternal nerve block significantly reduces postoperative pain and opioid use.

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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

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Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?

Cited by 3 publications

References 20 publications

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study

Median sternotomy pain after cardiac surgery: To block, or not? A systematic review and meta‐analysis

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

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