Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial

Background: Patients post-cardiac surgery face multiple challenges, but poorly controlled pain and atelectasis remain major issues that can prolong their recovery journey. The aim of this study was to compare two protocols of postoperative care in cardiac surgery: An enhanced recovery program consisting of high flow nasal oxygen therapy together with pectointercostal block, versus conventional postoperative care. Patients and Methods: Fifty adult participants above the age of 18, of either sex scheduled for cardiac surgery who required the utilization of cardiopulmonary bypass and median sternotomy approach, were included in the study. The participants were divided into ERAS Care group, where they received ultrasound-guided pectointercostal fascial plane block with subcutaneous local anaesthesia infiltration around the mediastinal drains and were extubated onto high flow nasal oxygen therapy (HFNO), and a Conventional (CONV) care group, where participants received fentanyl IV bolus dose followed by fentanyl IV infusion that was continued till the end of day zero and were extubated onto 6 L/min simple facemask. Results: Participants in the ERAS group had shorter ICU stay, lower numeric pain rating scale scores, less need for rescue analgesia, better oxygenation and lung aeration scores, better patient satisfaction, and less late pulmonary complications on discharge radiological screening. However, gastrointestinal complications and hospital stay were compared in both groups. Conclusion: ERAS care protocol in cardiac surgery patients led to shorter ICU ventilation periods, shorter ICU stay, better patient satisfaction and pain control, better oxygenation and lung aeration and less atelectasis on discharge radiology.

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“…This concurs with the study of Chen et al [37], regarding ultrasound-guided regional anaesthesia for postoperative median sternotomy pain.…”

Section: Discussionsupporting

confidence: 93%

Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

Halwag

Doghiem

Moustafa

et al. 2021

Egyptian Journal of Anaesthesia

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“…Fifteen studies evaluating four different regional anesthesia techniques were finally included for quantitative and qualitative analysis. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The regional and local anesthesia techniques included the pecto-intercostal fascial (PIF), transversus thoracis muscle plane (TTMP), erector spinae plane (ESP), and pectoralis nerve (PECS) I blocks ( Fig. 2).…”

Section: Study Selection and Data Retrievalmentioning

confidence: 99%

Effects of ultrasound-guided regional anesthesia in cardiac surgery: A systematic review and network meta-analysis

Dost

Cassai

Balzani

et al. 2022

Preprint

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Background and aim The objective of this systematic review and network meta-analysis was to compare the effects of single-shot ultrasound-guided regional anesthesia techniques on postoperative opioid consumption in patients undergoing open cardiac surgery. Methods This systematic review and network meta-analysis involved cardiac surgical patients (age >18 y) requiring median sternotomy. We searched PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. The effects of the single-shot ultrasound-guided regional anesthesia technique were compared with those of placebo and no intervention. Results The primary outcome was opioid consumption during the first 24 h after surgery. The secondary outcomes were pain after extubation at 12 and 24 h, postoperative nausea and vomiting, extubation time, intensive care unit discharge time, and length of hospital stay. Fifteen studies with 849 patients were included. The regional anesthesia techniques included pecto-intercostal fascial block, transversus thoracis muscle plane block, erector spinae plane (ESP) block, and pectoralis nerve block I. All the regional anesthesia techniques included significantly reduced postoperative opioid consumption at 24 hours, expressed as morphine milligram equivalents (MME). The ESP block was the most effective treatment (-22.93 MME [-34.29;-11.56]). Conclusions In this meta-analysis, we concluded that fascial plane blocks were better than placebo when evaluating 24 hr MMEs. However, it is still challenging to determine which is better, given the paucity of studies available in the literature. More randomized controlled trials are required to determine which regional anesthesia technique is better.

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“…They applied local anesthetic in the 3rd and 5th parasternal intercostal spaces bilaterally. The PSIB group required 20% less sufentanil added by the patient-controlled analgesia (PCA) pump compared to the control group and reported lower pain scores in rest and cough 24 hours after surgery [58].…”

Section: Parasternal Intercostal Nerve Blockmentioning

confidence: 99%

Regional anesthesia for cardiothoracic surgery

2022

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Cardiac and thoracic surgery have been connected to high perioperative opioid use for a long time. With increasing knowledge of regional anesthesia in the thoracic region, thoracic nerve blocks have become supplemental methods of analgesia. As part of multimodal analgesia, they are important factors of enhanced recovery after surgery and contribute to a diminished opioid use. Myofascial nerve blocks are more superficial than the classic thoracic epidural anesthesia or paravertebral block and are therefore safer for use in anticoagulated patients. In this article, we present a number of thoracic blocks; the paraneuraxial paravertebral block; the myofascial plane blocks which are the retrolaminar block, the erector spinae plane block, the serratus anterior plane block, the pectoral nerves I and II block, the transversus thoracis plane block and the parasternal intercostal nerve block; the perineural intercostal nerve block and also local anesthetic infusion by a wound catheter. We conclude with local experience from a cardiac and thoracic surgical center.

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Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial

Cited by 16 publications

References 31 publications

Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

Effects of ultrasound-guided regional anesthesia in cardiac surgery: A systematic review and network meta-analysis

Regional anesthesia for cardiothoracic surgery

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