Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study
Abstract Background Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane bloc...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00134-2 |
| _version_ | 1827707645166878720 |
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| author | Antonio Toscano Paolo Capuano Chiara Perrucci Matteo Giunta Alberto Orsello Tommaso Pierani Andrea Costamagna Mario Tedesco Antonio Arcadipane Giuseppe Sepolvere Gabriella Buono Luca Brazzi |
| author_facet | Antonio Toscano Paolo Capuano Chiara Perrucci Matteo Giunta Alberto Orsello Tommaso Pierani Andrea Costamagna Mario Tedesco Antonio Arcadipane Giuseppe Sepolvere Gabriella Buono Luca Brazzi |
| author_sort | Antonio Toscano |
| collection | DOAJ |
| description | Abstract Background Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively. Methods We designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction. Results Ninety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00–3.00), 2.00 (0.00–5.50), and 15.60 mg (9.60–30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group. Conclusions Both SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs. |
| first_indexed | 2024-03-10T16:51:28Z |
| format | Article |
| id | doaj.art-1661212da5d94a8f86878724d34de023 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-03-10T16:51:28Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-1661212da5d94a8f86878724d34de0232023-11-20T11:16:29ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-11-01311910.1186/s44158-023-00134-2Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational studyAntonio Toscano0Paolo Capuano1Chiara Perrucci2Matteo Giunta3Alberto Orsello4Tommaso Pierani5Andrea Costamagna6Mario Tedesco7Antonio Arcadipane8Giuseppe Sepolvere9Gabriella Buono10Luca Brazzi11Department of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMCDivision of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine MaurizianoDepartment of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalDepartment of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalDepartment of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalDepartment of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalDepartment of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei HospitalDepartment of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMCDepartment of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa di Cura San MicheleDivision of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine MaurizianoDepartment of Anesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ HospitalAbstract Background Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively. Methods We designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction. Results Ninety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00–3.00), 2.00 (0.00–5.50), and 15.60 mg (9.60–30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group. Conclusions Both SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs.https://doi.org/10.1186/s44158-023-00134-2Fascial plane blocksParasternal blocksCardiac surgical proceduresHeart surgical procedureMedian sternotomyNerve blocks |
| spellingShingle | Antonio Toscano Paolo Capuano Chiara Perrucci Matteo Giunta Alberto Orsello Tommaso Pierani Andrea Costamagna Mario Tedesco Antonio Arcadipane Giuseppe Sepolvere Gabriella Buono Luca Brazzi Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study Journal of Anesthesia, Analgesia and Critical Care Fascial plane blocks Parasternal blocks Cardiac surgical procedures Heart surgical procedure Median sternotomy Nerve blocks |
| title | Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study |
| title_full | Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study |
| title_fullStr | Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study |
| title_full_unstemmed | Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study |
| title_short | Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study |
| title_sort | which ultrasound guided parasternal intercostal nerve block for post sternotomy pain results from a prospective observational study |
| topic | Fascial plane blocks Parasternal blocks Cardiac surgical procedures Heart surgical procedure Median sternotomy Nerve blocks |
| url | https://doi.org/10.1186/s44158-023-00134-2 |
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