Effects of Parasternal Block on Acute and Chronic Pain in Patients Undergoing Coronary Artery Surgery

Abstract

Background Sternotomy causes considerable postoperative pain and postoperative pain management encompasses different analgesic regimens. In this study, we aimed to investigate the effect of peroperative parasternal block with levobupivacaine on acute and chronic pain after coronary artery bypass graft surgery. Materials and Methods A total of 81 patients undergoing coronary artery bypass graft surgery were included in this study. Patients were randomly allocated by opening an envelope to receive either parasternal block with pharmacologic analgesia (group P; before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with local anesthetics) or pharmacologic analgesia alone (group C) for postoperative pain relief. All patients received intravenous tramadol with patient-controlled analgesia at the end of the surgery. Demographic characteristics, vital signs, tramadol consumption, analgesic intake, and intensity of pain with a visual analogue scale were recorded for each patient. Six months after surgery, the patients' type of chronic pain was evaluated using the Leeds Assessment Neuropathic Symptoms and Signs pain scale questionnaire. Results Patients who received parasternal block experienced less pain and needed less opioid analgesic (125.75 ± 28.9 mg in group P vs 213.17 ± 61.25 mg in group C) for 24 hours postoperatively (P < .001). There was no significant difference in nociceptive and neuropathic pain between the groups. Conclusion Parasternal block had a benefical effect on the management of postoperative acute pain and decreased opioid consumption after surgery but had no significant effect in chronic post surgical pain.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

“…Some reported double blinding but did not provide details (Bell 2001; Comez 2015; Paxton 1995; Pinzur 1996). Six studies described out-come assessor blinding, without detail on personnel or participant blinding (Burney 2004; Dogan 2016; Ibarra 2011; Lam 2015; Lavand’homme 2005; O’Neill 2012), but nine other studies neither described nor confirmed it (Bell 2001; Choi 2016; Katsuly-Liapis 1996; Liu 2015; Lu 2008; Okur 2016; Wodlin 2011; Xu 2017; Zhou 2016). …”

“…There was a trend toward more adequate addressing of incomplete outcome data in more recent studies (Albi-Feldzer 2013; Bell 2001; Blumenthal 2005; Brown 2004; Can 2013; Comez 2015; Dogan 2016; Fassoulaki 2000; Fassoulaki 2005; Fassoulaki 2016; Gacio 2016; Grigoras 2012; Gundes 2000; Gupta 2006; Kairaluoma 2006; Karanikolas 2006; Karmakar 2014; Kurmann 2015; Lavand’homme 2007; McKeen 2014; Mounir 2010; O’Neill 2012; Okur 2016; Purwar 2015; Shahin 2010; Singh 2007; Sprung 2006; Terkawi 2015b; Vrooman 2015; Weber 2007; Xu 2017). compared to those that are older (Katsuly-Liapis 1996; Katz 1996; Katz 2004; Lavand’homme 2005; Paxton 1995; Senturk 2002).…”

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

“…[ 16 19 20 ] One study compared parasternal block with pharmacologic analgesia and another with Trans cutaneous electric nerve stimulation (TENS). [ 17 18 ] Lower pain scores, lower opioid consumption were reported by all authors except Mc Donald and colleagues who could not elicit superiority of pain control in the parasternal block group. [ 16 ] Dogan et al .…”

“…The procedure of this block involves injection of local anesthetic solution bilaterally on the 2 nd to 6 th intercostal spaces just before placement of sternal wires. [ 16 17 18 19 ] This is usually supplemented with infiltration of local anesthetic solution over the periosteum and infiltration around the chest tubes [ Figure 2 ]. The intercostal injection blocks the anterior cutaneous branch which is the terminal portion of the main trunk of intercostal nerve.…”

Efectividad de la analgesia controlada por el paciente en el dolor agudo y crónico de los pacientes después de cirugía cardiaca: estudio prospectivo

“…Revisada la literatura sobre la efectividad analgésica, esta se definió como una reducción del 20 % en la puntuación de la EN en el grupo PCA (13). Con un poder de 0,8 y un nivel de significación del 0,05, se necesitarían un mínimo de 26 pacientes en cada grupo.…”