Efficacy of bilateral catheter superficial parasternal intercostal plane blocks using programmed intermittent bolus for opioid-sparing postoperative analgesia in cardiac surgery with sternotomy: A randomized, double-blind, placebo-controlled trial - 25/04/24
, Yi Liao a, 1 , Xiaoe Wang a , Mingying Zhan b , Li Xiao a, ⁎, 2 , Yu Chen a, 2, ⁎⁎ Abstract |
Study objective |
This study investigated whether catheter superficial parasternal intercostal plane (SPIP) blocks, using a programmed intermittent bolus (PIB) with ropivacaine, could reduce opioid consumption while delivering enhanced analgesia for a period exceeding 48 h following cardiac surgery involving sternotomy.
Design |
A double-blind, prospective, randomized, placebo-controlled trial.
Setting |
University-affiliated tertiary care hospital.
Patients |
60 patients aged 18 or older, scheduled for cardiac surgery via sternotomy.
Interventions |
The patients were randomly assigned in a 1:1 ratio to either the ropivacaine or saline group. After surgery, patients received bilateral SPIP blocks for 48 h with 0.4% ropivacaine (20 mL per side) for induction, followed by bilateral SPIP catheters using PIB with 0.2% ropivacaine (8 mL/side, interspersed with a 2-h interval) or 0.9% normal saline following the same administration schedule. All patients were administered patient-controlled analgesia with hydromorphone.
Measurements |
The primary outcome was the cumulative morphine equivalent consumption during the initial 48 h after the surgery. Secondary outcomes included postoperative pain assessment using the Numeric Rating Scale (NRS) at rest and during coughing at designated intervals for three days post-extubation. Furthermore, recovery indicators and ropivacaine plasma levels were diligently documented.
Main results |
Cumulative morphine consumption within 48 h in ropivacaine group decreased significantly compared to saline group (25.34 ± 31.1 mg vs 76.28 ± 77.2 mg, respectively; 95% CI, −81.9 to −20.0, P = 0.002). The ropivacaine group also reported lower NRS scores at all recorded time points (P < 0.05) and a lower incidence of nausea and vomiting than the saline group (3/29 vs 12/29, respectively; P = 0.007). Additionally, the ropivacaine group showed significant improvements in ambulation (P = 0.018), respiratory exercises (P = 0.006), and self-reported analgesia satisfaction compared to the saline group (P = 0.016).
Conclusions |
Bilateral catheter SPIP blocks using PIB with ropivacaine reduced opioid consumption over 48 h, concurrently delivering superior postoperative analgesia in adult cardiac surgery with sternotomy.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Postoperative pain after cardiac surgery is challenging. |
• | Catheter superficial parasternal intercostal plane blocks using a programmed intermittent bolus regimen reduced the morphine equivalent requirement up to three days after surgery. |
• | The technique also reduces the incidence of postoperative nausea and vomiting, facilitating postoperative recovery. |
Keywords : Superficial parasternal intercostal plane block catheters, Programmed intermittent bolus, Opioid-sparing analgesia, Postoperative pain, Cardiac surgery
Plan
Vol 95
Article 111430- août 2024 Retour au numéro
Article précédent
- Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial
- Tianyuan Luo, Zhimin Deng, Qiyang Ren, Fangfang Mu, You Zhang, Haiying Wang
- General anesthesia is not associated with dementia in older adults with osteoarthritis for hip/knee replacements, a national population-based nested case-control study
- Yuting Lin, Chun-Chia Chen, Chen Dong, Yu-Ze Luan, Jing-Yang Huang, James Cheng-Chung Wei, Jeng-Yuan Chiou
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?