Addition of Deep Parasternal Plane Block to Enhanced Recovery Protocol for Pediatric Cardiac Surgery

Abstract

Purpose

This study aims to evaluate if the addition of deep parasternal plane blocks to a pre-existing enhanced recovery pathway for pediatric cardiac surgery improves outcomes.

Patients and Methods

A retrospective review through an EMR query from June 2019 to June 2021 was performed for patients less than 18 years of age who underwent cardiac surgery via median sternotomy and were extubated immediately following surgery in a single academic tertiary care hospital. Patients receiving deep parasternal blocks as part of an enhanced recovery protocol were compared to similar patients from the year prior to block implementation.

Results

The primary outcome was intraoperative and postoperative opioid consumption. Secondary outcomes were pain scores, intensive care unit (ICU) length of stay and time to first oral intake. There was a statistically significant reduction in intraoperative opioid administration and pain scores in the first 24 hours post-operatively. There was also a statistically significant reduction in ICU length of stay. There was no statistically significant difference in post-operative opioid consumption and time to first oral intake.

Conclusion

Bilateral deep parasternal blocks may reduce opioid consumption, provide effective postoperative pain control, and result in decreased length of intensive care unit stay across both simple and complex pediatric cardiac procedures when added to a pre-existing enhanced recovery protocol.

Keywords:

• enhanced recovery after surgery
• pediatric cardiac surgery
• congenital heart disease
• regional anesthesia
• truncal blocks

Acknowledgments

Non-Author Collaborators-Janessa Thirion, NP and Carrie Williams, NP Rainbow Babies & Children’s Hospital-Pediatric Pain Service, 11100 Euclid Ave, Cleveland, OH 44106.

Sarah DeLozier, PhD, Clinical Research Biostatistician–University Hospitals Cleveland Medical Center, Clinical Research Center, 11100 Euclid Ave, Cleveland, OH 44106.

This publication was made possible through the support of the Clinical Research Center of University Hospitals Cleveland Medical Center (UHCMC) and the Case Western Reserve University Clinical and Translational Science Collaborative (CTSC) 4UL1TR000439. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of UHCMC or NIH.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.