Abstract

BackgroundUltrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection.MethodsThis randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18–65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 h.ResultsThere were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg, P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls.ConclusionsUSG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.

Highlights

  • Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear

  • Resection of a mediastinal mass by median sternotomy imparts substantial pain, which increases during movement and typically leads to chronic post-sternotomy pain as well as reduced pulmonary function caused by atelectasis and pneumonia [3, 4]

  • Patients Participants between 18 and 65 years old with American Society of Anesthesiologists (ASA) scores of I-II scheduled for elective mediastinal mass resection by median sternotomy between October 2018 and July 2019 were included

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Summary

Introduction

Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection. Parasternal intercostal nerve block (PSI) principally blocks anterior cutaneous intercostal nerves, and is used as an adjuvant for pain management post-cardiac surgery. This modality is highly effective in patients experiencing sternal wound pain following cardiac surgery [7,8,9,10]. USG parasternal intercostal nerve block in postoperative analgesia is rarely reported, especially in the context of thoracic surgeries involving median sternotomy for mediastinal mass resection [11,12,13,14].

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