Parasternal block reduces opioids in open heart surgery: Pilot study

Recently, opioid-sparing methods in cardiac surgery have been developed for faster emergence from anesthesia and recovery after surgery. Several cardiac surgery protocols used multimodal analgesia with the application of regional anesthesia techniques. This study aims to assess the effect of preoperative bilateral ultrasound-guided deep parasternal intercostal plane block (DPIPB) on intraoperative adult open-heart surgery opioid consumption.

The Institutional Ethics Committee has approved this study. This was a double-blind, randomized, controlled study with two parallel groups. Patients aged 19–75 years old who would undergo elective open-heart surgery with a median sternotomy approach were included in this study. Participants were randomly assigned to either DPIPB or control group with a 1:1 allocation. The measured outcomes were total intraoperative fentanyl consumption, the time of first intraoperative analgetic rescue, and the injury of the internal thoracic artery.

Thirty-four patients were recruited, and two subjects were withdrawn. The subject’s baseline characteristics were comparable. The total intraoperative fentanyl consumption was significantly higher in the control group than in the DPIPB group (median of 200 [100] vs 100 [50] mcg, p=<0.001). The time of the first intraoperative analgetic rescue was significantly longer in the DPIPB group than in the control group (median of 121.5 [141.5] vs 4.5 [4.75] minutes, p=<0.001). No injury of the internal thoracic artery was found.

The preoperative bilateral DPIPB is effective for reducing intraoperative opioid consumption in adult open-heart surgery and, therefore, can be used as a regional anesthesia technique as part of multimodal analgesia for enhanced recovery after cardiac surgery protocol.