Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study

Abstract

Objective

The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, and determine the duration of preemptive DPIP block at the T3-4 or T4-5 intercostal spaces in patients undergoing coronary artery bypass grafting (CABG) via sternotomy.

Design

A prospective, single-blind, randomized controlled trial.

Setting

Patients were randomly divided into three cohorts, each containing thirty patients.

Participants

Ninety patients who underwent elective CABG via sternotomy were included in this study.

Interventions

The T3-4 and T4-5 groups received a preoperative single-shot DPIP block at the respective intercostal spaces. The principal objective of the study was to ascertain the optimal dosage of sufentanil administered during surgical procedures involving either a DPIP block or its absence, and to conduct a comparative analysis thereof across distinct injection sites, specifically T3-4 and T4-5. Secondary factors considered were the dosage of postoperative analgesics, the extent of sensory block on the skin, pain levels after extubation, time of recovery from anesthesia (time to extubation), duration of the block, and the occurrence of nausea and vomiting.

Measurements & Main Results

Preemptive DPIP block significantly reduced intraoperative sufentanil requirement compared to the control group (T3-4:0.38 ± 0.1, T4-5:0.32 ± 0.10, vs. Control:0.88 ± 0.3 μg/kg/h, p < 0.001). It also resulted in decreased analgesic consumption and numeric rating scale scores on the day of surgery (p < 0.01 compared to the control group). The DPIP block provided accurate anesthetic coverage of the dermatomes in the sternal region and reduced the time to extubation and postoperative nausea. However, the injection point (either via the T3-4 intercostal or the T4-5 intercostal) did not affect the efficacy. Preoperative DPIP block failed to provide adequate analgesia beyond 24 h post-surgery.

Conclusion

Preemptive bilateral DPIP block provided effective analgesia in patients undergoing CABG during surgery and in the early postoperative period. The analgesic effects of the DPIP block in the T3-4 and T4-5 intercostal spaces were comparable.

Keywords:

• Anesthetized dermatomes
• coronary artery bypass grafting
• deep parasternal intercostal plane block
• perioperative analgesia

Acknowledgements

We would like to acknowledge the hard and dedicated work of all the staff who implemented the intervention and evaluation components of the study.

Authors contributions

Yu Chen and Qi Li conceived the idea and conceptualised the study. Yi Liao, Ying-yuan Li, Mingying Zhan and Gai-jiao Liu collected the data. Yi Liao, Xiao-e Wang and Qi Li analysed the data. Yu Chen and Qi Li drafted the manuscript, then Qi Li and Li Xiao reviewed the manuscript. All authors read and approved the final draft.

Competing interests

The authors declare that they have no competing interests.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

I confirm that I read the Editorial Policy pages. This study was approved by the Ethics Committee of The First Affiliated Hospital of Sun Yat-sen University(approval number: [2019]386). This study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all the participants.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.