The Effect of Parasternal Block on Postoperative Pain in Patients Undergoing Coronary Artery Bypass Graft Surgery

Summary

Objective: This study aims to investigate the effects of intraoperative parasternal block on postoperative analgesia in patients undergoing elective coronary artery bypass graft surgery. Materials and Methods: This prospective, randomized, double-blind study included 78 patients aged 30-80 years with an ASA (American Society of Anesthesiologists) risk score of III-IV, who were scheduled for elective coronary artery bypass graft surgery. Patients were randomly assigned into two groups: the parasternal block group (n = 39), receiving parasternal block with 2.5% bupivacaine, and the saline group (n = 39), receiving parasternal block with 0.9% NaCl. All patients were administered a standard anesthesia protocol, and routine care and analgesia practices during the postoperative period were not interfered with. Patients in the intensive care unit received intravenous paracetamol every 8 hours for analgesia. If postoperative 24-hour pain scores in the intensive care unit , assessed using the Behavioral Pain Scale while intubated and the Numeric Rating Scale while extubated, exceeded 4, 1 mg/kg tramadol was administered. The timing and doses of the first tramadol administration, as well as extubation times, intensive care unit stay durations, and discharge times, were recorded. Results: In the postoperative period, Behavioral Pain Scale scores at the 8th hour and Numeric Rating Scale scores at the 4th and 12th hours were significantly lower in the parasternal block group compared to the saline group (p \< 0.005). The average extubation time was 8.76 hours in the parasternal block group and 14.76 hours in the saline group (p \< 0.001). Among patients with pain scores of 4 or higher, the total tramadol consumption in the parasternal block group was 150 ± 64.72 mg, with the first tramadol administration occurring at 17.26 ± 4.78 hours. In the saline group, total tramadol consumption was 212.5 ± 82.23 mg, and the first administration occurred at 12.35 ± 5.75 hours. Conclusion: Our study demonstrated that parasternal block, as a component of multimodal analgesia, improved postoperative analgesia levels in coronary artery bypass graft surgery. Therefore, the investigators consider parasternal block to be effective in pain management following median sternotomy.

Timeline

Start

2020-01-18

Primary completion

2020-10-17

Completion

2020-10-17

Publications

• Results Li Q, Liao Y, Wang X, Zhan M, Xiao L, Chen Y. 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. J Clin Anesth. 2024 Aug;95:111430. doi: 10.1016/j.jclinane.2024.111430. Epub 2024 Mar 26.
• Results Coriat P, Beaussier M. Fast-tracking after coronary artery bypass graft surgery. Anesth Analg. 2001 May;92(5):1081-3. doi: 10.1097/00000539-200105000-00001. No abstract available.
• Results Schiavoni L, Nenna A, Cardetta F, Pascarella G, Costa F, Chello M, Agro FE, Mattei A. Parasternal Intercostal Nerve Blocks in Patients Undergoing Cardiac Surgery: Evidence Update and Technical Considerations. J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4173-4182. doi: 10.1053/j.jvca.2022.07.025. Epub 2022 Jul 24.
• Results Dogan Baki E, Kavrut Ozturk N, Ayoglu RU, Emmiler M, Karsli B, Uzel H. Effects of Parasternal Block on Acute and Chronic Pain in Patients Undergoing Coronary Artery Surgery. Semin Cardiothorac Vasc Anesth. 2016 Sep;20(3):205-12. doi: 10.1177/1089253215576756. Epub 2015 Apr 21.
• Results Schwann NM, Chaney MA. No pain, much gain? J Thorac Cardiovasc Surg. 2003 Nov;126(5):1261-4. doi: 10.1016/s0022-5223(03)01327-8. No abstract available.
• Results Grant MC, Chappell D, Gan TJ, Manning MW, Miller TE, Brodt JL; PeriOperative Quality Initiative (POQI) and the Enhanced Recovery After Surgery (ERAS) Cardiac Society Workgroup. Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. J Thorac Cardiovasc Surg. 2023 Dec;166(6):1695-1706.e2. doi: 10.1016/j.jtcvs.2023.01.020. Epub 2023 Jan 28.
• Results Hassan S, Stambulic T, King M, Norman P, Payne D, Derry K, et al. Post-Operatıve Paın And Analgesıc Use For Cardıac Surgery Wıth Medıan Sternotomy. Canadian Journal of Cardiology. 2021 Oct 1;37(10):S107-8.
• Results Barr AM, Tutungi E, Almeida AA. Parasternal intercostal block with ropivacaine for pain management after cardiac surgery: a double-blind, randomized, controlled trial. J Cardiothorac Vasc Anesth. 2007 Aug;21(4):547-53. doi: 10.1053/j.jvca.2006.09.003. Epub 2006 Dec 22.
• Results Padala SRAN, Badhe AS, Parida S, Jha AK. Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. J Card Surg. 2020 Jul;35(7):1525-1530. doi: 10.1111/jocs.14651. Epub 2020 Jun 24.
• Results Kelava M, Alfirevic A, Bustamante S, Hargrave J, Marciniak D. Regional Anesthesia in Cardiac Surgery: An Overview of Fascial Plane Chest Wall Blocks. Anesth Analg. 2020 Jul;131(1):127-135. doi: 10.1213/ANE.0000000000004682.
• Results Fuchs A, Heinisch PP, Luedi MM, Reid CS. Pain after cardiac surgery: Time to include multimodal pain management concepts in ERAS protocols. J Clin Anesth. 2022 Feb;76:110583. doi: 10.1016/j.jclinane.2021.110583. Epub 2021 Nov 10. No abstract available.
• Results Landoni G, Isella F, Greco M, Zangrillo A, Royse CF. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015 Jul;115(1):25-32. doi: 10.1093/bja/aev201.
• Results McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, Hall RA. Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesth Analg. 2005 Jan;100(1):25-32. doi: 10.1213/01.ANE.0000139652.84897.BD.
• Results Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006 May 13;367(9522):1618-25. doi: 10.1016/S0140-6736(06)68700-X.
• Results Bigeleisen PE, Goehner N. Novel approaches in pain management in cardiac surgery. Curr Opin Anaesthesiol. 2015 Feb;28(1):89-94. doi: 10.1097/ACO.0000000000000147.
• Results Kwanten LE, O'Brien B, Anwar S. Opioid-Based Anesthesia and Analgesia for Adult Cardiac Surgery: History and Narrative Review of the Literature. J Cardiothorac Vasc Anesth. 2019 Mar;33(3):808-816. doi: 10.1053/j.jvca.2018.05.053. Epub 2018 Jun 5.
• Results Huang AP, Sakata RK. [Pain after sternotomy - review]. Rev Bras Anestesiol. 2016 Jul-Aug;66(4):395-401. doi: 10.1016/j.bjan.2014.09.003. Epub 2015 Mar 18. Portuguese.
• Results Reinhart M, Jonsson M, Enthoven P, Westerdahl E. Immediate effects of upper limb exercises with and without deep breathing on lung function after cardiac surgery - a randomized crossover trial. J Cardiothorac Surg. 2024 Aug 28;19(1):503. doi: 10.1186/s13019-024-03007-z.
• Results Nalysnyk L, Fahrbach K, Reynolds MW, Zhao SZ, Ross S. Adverse events in coronary artery bypass graft (CABG) trials: a systematic review and analysis. Heart. 2003 Jul;89(7):767-72. doi: 10.1136/heart.89.7.767.

Drugs

Indications

No indication recorded.