Parasternal intercostal block with ropivacaine for pain management after cardiac surgery: a double-blind, randomized, controlled trial.
OBJECTIVE
The purpose of this study was to test the hypothesis that administration of a parasternal intercostal block using ropivacaine 0.75% improved analgesia in postoperative cardiac surgical patients.


METHODS
Randomized, controlled, double-blinded trial.


METHODS
Teaching hospital.


METHODS
Eighty-eight cardiac surgery patients.


METHODS
Ropivacaine 0.75% with 5 doses each side, total dosage 40 mL (300 mg), via parasternal intercostal injection or saline before insertion of the sternal wires and closure of the sternal wound.


RESULTS
At extubation, patients who had a parasternal intercostal block with ropivacaine had visual analog and numerical rating pain scores approximately 50% less than those in the saline group (29.5 [standard deviation (SD) = 24.3] v 53.2 [SD = 24.1], ropivacaine v saline, respectively, p < 0.001). Patients who received ropivacaine used approximately 50% less PCA morphine (12.0 [SD = 5.4] v 23.2 [SD = 8.3] total morphine equivalents in milligrams, ropivacaine v saline, respectively; p < 0.001) in the first 12 hours postoperatively, with a continued reduction in dosages for the ensuing 12 to 24 hours (18.8 [SD = 9.6] v 23.7 [SD = 10.0] total morphine equivalents in milligrams, ropivacaine v saline; p = 0.028).


CONCLUSIONS
A ropivacaine parasternal intercostal block is a safe, simple, and effective adjunct for optimizing of pain control and reducing opioid analgesics after adult cardiac surgery. This study provides clinicians with an effective treatment for sternal wound pain.
Department of Cardiothoracic Surgery, Southern Health, Monash Medical Centre, Victoria, Australia. albarr@iprimus.com.au
Althea M
AM
Barr
Elli
E
Tutungi
Aubrey A
AA
Almeida
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001917:Brachial Plexus / Q000187:drug effects; D004008:Diclofenac / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D007367:Intercostal Nerves / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*; D011013:Pneumonectomy / Q000379:methods; D011446:Prospective Studies; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000077212:Ropivacaine