Deep Parasternal Intercostal Plane Block for Postoperative Analgesia After Sternotomy for Cardiac Surgery—A Retrospective Cohort Study

Abstract

ObjectiveTo examine the analgesic efficacy of postoperative deep parasternal intercostal plane (DPIP) blocks for patients having cardiac surgery via median sternotomy. DesignSingle-center retrospective study compared patients receiving bilateral DPIP blocks with a matched cohort of patients not receiving DPIP blocks. SettingLarge quaternary referral center. ParticipantsAdult patients admitted to authors’ institution from January 1, 2016 to August 14th, 2020 for elective cardiac surgery via median sternotomy. InterventionsPatients received ultrasound-guided bilateral DPIP blocks. Measurements and Main Results113 patients received a DPIP block; 3461 patients did not. Estimated multiplicative change in cumulative opioid consumption through 24 hours was 0.42 (95% CI 0.32 to 0.56; p < 0.001), indicating patients receiving DPIP blocks required 60% less opioids than patients who did not. Proportional odds ratios for average pain score on POD 0 was 0.46 (95% CI 0.32 to 0.65; p< 0.001) and POD 1 was 0.67 (95% CI 0.47 to 0.94; p=0.021), indicating lower pain scores for patients receiving blocks. Exploratory analysis identified an inverse correlation between DPIP blocks and atrial fibrillation incidence (2% vs 15%; IPTW odds ratio 0.088, 95% CI 0.02 to 0.41; p=0.002). ConclusionsThe use of deep parasternal intercostal plane blocks in patients undergoing cardiac surgery via median sternotomy was associated with less opioid use and improved pain scores in the early postoperative period compared to patients not receiving blocks. Prospective randomized controlled studies should further elucidate efficacy and risks of DPIP blocks in cardiac surgery.