Abstract
Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.
Highlights
The sternal incision causes intense pain after cardiac surgery [1], and the pain increases during movement [2]
After obtaining written informed consent from the parents of 100 participating children, using the sealed envelope method, 100 children undergoing corrective cardiac surgery on CPB were randomized into group R, group B or group S given either ropivacaine, bupivacaine or saline
Patients received a parasternal block with 0.5% ropivacaine, 0.25% bupiacaine or 0.9% saline administered in 0.5- to 2-mL aliquots depending on the weight injected into 5 anterior (2nd-6th) intercostal spaces on each side 1 to 1.5 cm lateral to the sternal edge
Summary
The sternal incision causes intense pain after cardiac surgery [1], and the pain increases during movement [2]. Optimal pain management after cardiac surgery improves the comfort and well-being of patients, but more importantly, has physiologic benefits. The doses of opioids necessary to provide effective pain relief may delay tracheal extubation because of side effects such as respiratory depression, sedation, and gastrointestinal side effects (e.g., nausea, vomiting, and ileus). Epidural analgesia [4] may provide better analgesia, with reduced opioid use, earlier extubation, and improved respiratory function. Concerns related to systemic hypotension and resulting decreasing coronary perfusion, and the possibility of a devastating epidural hematoma after aspirin therapy and full heparinization have resulted in regional analgesia not being widely used in cardiac surgical patients [5] [6]
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