Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study
AbstractObjective The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, an...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2024.2302983 |
| _version_ | 1797302181658886144 |
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| author | Yu Chen Qi Li Yi Liao Xiaoe Wang Ming-ying Zhan Ying-yuan Li Gai-jiao Liu Li Xiao |
| author_facet | Yu Chen Qi Li Yi Liao Xiaoe Wang Ming-ying Zhan Ying-yuan Li Gai-jiao Liu Li Xiao |
| author_sort | Yu Chen |
| collection | DOAJ |
| description | AbstractObjective The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, and determine the duration of preemptive DPIP block at the T3-4 or T4-5 intercostal spaces in patients undergoing coronary artery bypass grafting (CABG) via sternotomy.Design A prospective, single-blind, randomized controlled trial.Setting Patients were randomly divided into three cohorts, each containing thirty patients.Participants Ninety patients who underwent elective CABG via sternotomy were included in this study.Interventions The T3-4 and T4-5 groups received a preoperative single-shot DPIP block at the respective intercostal spaces. The principal objective of the study was to ascertain the optimal dosage of sufentanil administered during surgical procedures involving either a DPIP block or its absence, and to conduct a comparative analysis thereof across distinct injection sites, specifically T3-4 and T4-5. Secondary factors considered were the dosage of postoperative analgesics, the extent of sensory block on the skin, pain levels after extubation, time of recovery from anesthesia (time to extubation), duration of the block, and the occurrence of nausea and vomiting.Measurements & Main Results Preemptive DPIP block significantly reduced intraoperative sufentanil requirement compared to the control group (T3-4:0.38 ± 0.1, T4-5:0.32 ± 0.10, vs. Control:0.88 ± 0.3 μg/kg/h, p < 0.001). It also resulted in decreased analgesic consumption and numeric rating scale scores on the day of surgery (p < 0.01 compared to the control group). The DPIP block provided accurate anesthetic coverage of the dermatomes in the sternal region and reduced the time to extubation and postoperative nausea. However, the injection point (either via the T3-4 intercostal or the T4-5 intercostal) did not affect the efficacy. Preoperative DPIP block failed to provide adequate analgesia beyond 24 h post-surgery.Conclusion Preemptive bilateral DPIP block provided effective analgesia in patients undergoing CABG during surgery and in the early postoperative period. The analgesic effects of the DPIP block in the T3-4 and T4-5 intercostal spaces were comparable. |
| first_indexed | 2024-03-07T23:33:05Z |
| format | Article |
| id | doaj.art-f793d2d3115e4d9ba4942b2afee4d95d |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-03-07T23:33:05Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
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| series | Annals of Medicine |
| spelling | doaj.art-f793d2d3115e4d9ba4942b2afee4d95d2024-02-20T11:58:24ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602023-12-0155210.1080/07853890.2024.2302983Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled studyYu Chen0Qi Li1Yi Liao2Xiaoe Wang3Ming-ying Zhan4Ying-yuan Li5Gai-jiao Liu6Li Xiao7Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaDepartment of Anesthesiology, Shenzhen Second People’s Hospital, Shenzhen, ChinaDepartment of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, ChinaAbstractObjective The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, and determine the duration of preemptive DPIP block at the T3-4 or T4-5 intercostal spaces in patients undergoing coronary artery bypass grafting (CABG) via sternotomy.Design A prospective, single-blind, randomized controlled trial.Setting Patients were randomly divided into three cohorts, each containing thirty patients.Participants Ninety patients who underwent elective CABG via sternotomy were included in this study.Interventions The T3-4 and T4-5 groups received a preoperative single-shot DPIP block at the respective intercostal spaces. The principal objective of the study was to ascertain the optimal dosage of sufentanil administered during surgical procedures involving either a DPIP block or its absence, and to conduct a comparative analysis thereof across distinct injection sites, specifically T3-4 and T4-5. Secondary factors considered were the dosage of postoperative analgesics, the extent of sensory block on the skin, pain levels after extubation, time of recovery from anesthesia (time to extubation), duration of the block, and the occurrence of nausea and vomiting.Measurements & Main Results Preemptive DPIP block significantly reduced intraoperative sufentanil requirement compared to the control group (T3-4:0.38 ± 0.1, T4-5:0.32 ± 0.10, vs. Control:0.88 ± 0.3 μg/kg/h, p < 0.001). It also resulted in decreased analgesic consumption and numeric rating scale scores on the day of surgery (p < 0.01 compared to the control group). The DPIP block provided accurate anesthetic coverage of the dermatomes in the sternal region and reduced the time to extubation and postoperative nausea. However, the injection point (either via the T3-4 intercostal or the T4-5 intercostal) did not affect the efficacy. Preoperative DPIP block failed to provide adequate analgesia beyond 24 h post-surgery.Conclusion Preemptive bilateral DPIP block provided effective analgesia in patients undergoing CABG during surgery and in the early postoperative period. The analgesic effects of the DPIP block in the T3-4 and T4-5 intercostal spaces were comparable.https://www.tandfonline.com/doi/10.1080/07853890.2024.2302983Anesthetized dermatomescoronary artery bypass graftingdeep parasternal intercostal plane blockperioperative analgesia |
| spellingShingle | Yu Chen Qi Li Yi Liao Xiaoe Wang Ming-ying Zhan Ying-yuan Li Gai-jiao Liu Li Xiao Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study Annals of Medicine Anesthetized dermatomes coronary artery bypass grafting deep parasternal intercostal plane block perioperative analgesia |
| title | Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study |
| title_full | Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study |
| title_fullStr | Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study |
| title_full_unstemmed | Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study |
| title_short | Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study |
| title_sort | preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy a randomized observer blind controlled study |
| topic | Anesthetized dermatomes coronary artery bypass grafting deep parasternal intercostal plane block perioperative analgesia |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2024.2302983 |
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