Ultrasound Guided Parasternal Block for Perioperative Analgesia in Cardiac Surgery: A Prospective Study

Abstract

Ultrasound guided parasternal block is a regional anaesthesia technique targeting the anterior branches of intercostal nerves, which supply the anterior thoracic wall. The aim of this prospective study is to assess the efficacy of parasternal block to manage postoperative analgesia and reduce opioid consumption in patients undergoing cardiac surgery throughout sternotomy. A total of 126 consecutive patients were allocated to two different groups, receiving (Parasternal group) or not (Control group) preoperative ultrasound guided bilateral parasternal block with 20 mL of 0.5% ropivacaine per side. The following data were recorded: postoperative pain expressed by a 0–10 numeric rating scale (NRS), intraoperative fentanyl consumption, postoperative morphine consumption, time to extubation and perioperative pulmonary performance at incentive spirometry. Postoperative NRS was not significantly different between Parasternal and Control groups with a median (IQR) of 2 (0–4.5) vs. 3 (0–6) upon awakening (p = 0.07); 0 (0–3) vs. 2 (0–4) at 6 h (p = 0.46); 0 (0–2) vs. 0 (0–2) at 12 h (p = 0.57). Postoperative morphine consumption was similar among groups. However, intraoperative fentanyl consumption was significantly lower in the Parasternal group [406.3 ± 81.6 mcg vs. 864.3 ± 154.4, (p < 0.001)]. Parasternal group showed shorter times to extubation [(191 ± 58 min vs. 305 ± 72 min, (p)] and better performance at incentive spirometer with a median (IQR) of 2 raised balls (1–2) vs. 1 (1–2) after awakening (p = 0.04). Ultrasound guided parasternal block provided an optimal perioperative analgesia with a significant reduction in intraoperative opioid consumption, time to extubation and a better postoperative performance at spirometry when compared to the Control group.

Erector spinae plane block as an anesthesia technique for an emergent thoracotomy; a case report

“…However, the patient neither tolerated nor consented to that. The epidural, paravertebral, or intercostal nerve blocks are generally used for perioperative analgesia or to reduce the dosage of anesthetics [ 5 , 6 ]. However, an altered INR is the most crucial contraindication for a central block.…”

“…It is a less invasive option due to the avoidance of the neuraxial and paravertebral spaces. Furthermore, it is a safe technique used in various surgical interventions [ 6 , 10 ].…”

Preemptive parasternal intercostal nerve block for patients undergoing off-pump coronary artery bypass grafting: a double-blind, randomized, controlled trial

“…Poorly managed pain following cardiac surgery can lead to an increased risk of complications, such as lung collapse and chest infections, due to altered mechanical functions of the lungs and ventilation–perfusion mismatch. Pascarella et al showed that parasternal block provided a better postoperative performance at spirometry compared to the control group ( 27 ). Effective relief of sternal pain is important for both patients and physicians.…”

Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study

“…We upheld the diagnosis of persistent pain with an NRS ≥ 3, but our definition is questionable. In the context of postoperative pain, a threshold ≥ 4 is commonly used [ 19 ], but some authors have used an NRS of 3 [ 20 ], or the occurrence of a new pain symptom whatever the intensity (NRS > 0, [ 21 ]). In the context of critical care illness, Battle et al did not specify the intensity of pain symptoms [ 14 ].…”