Opioid-Sparing Analgesia After Cardiac Surgery with Continuous Bilateral Parasternal Subpectoral Plane Blocks
Morgan Harloff MD1, Edward Percy MD1, Sameer Hirji MD MPH1, Farhang Yazdchi MD MS1, Paige Newell MD1, Alexandra Malarczyka, Olena Cherkaskya, Kia Sedghi MD2, Andrew Shorten MD2, Daniel Rinewalt MD1, Sary Aranki MD1, Prem Shekar MD1, Dirk Varelmann MD2, Kamen Vlassakov MD2, Tsuyoshi Kaneko MD1
1Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Background: Regional anesthetic techniques, traditionally underutilized in cardiac surgery, may offer an opioid-sparing alternative. We investigated the efficacy of continuous bilateral parasternal subpectoral plane blocks (PSPB) after sternotomy.
Methods: We reviewed all opioid-naive patients who underwent cardiac surgery via sternotomy under our Enhanced Recovery After Surgery (ERAS) protocol between 5/2018-12/2019. Patients were grouped based on postoperative pain management strategy – those receiving standard ERAS multimodal analgesia alone (control group) versus those receiving ERAS multimodal analgesia plus continuous bilateral PSPB (block group). In the block group, one multiport catheter was placed under ultrasound-guidance in the subpectoral fascial plane on each side of the sternum. Continuous bupivacaine(0.125%) infusions were initiated at 5mL/hr through each catheter. The infusions were continued until catheter removal per perioperative care team discretion. Postoperative patient-reported numeric pain scale (NRS) scores and opioid consumption in morphine milligram equivalents (MME) were compared between groups through post-operative day (POD) 6.
Results: Of 293 patients included in the study, the block group comprised of 104(35%) patients. While baseline characteristics between groups were similar, average pain scores were significantly lower in the block group through POD4 when the catheters were typically removed (Panel A). Opioid consumption was significantly lower in the block group through POD5 (all P-values<0.05) (Panel B). Conclusions: Continuous bilateral PSPB plus ERAS multimodal analgesia provides a safe and effective pain management strategy that can dramatically reduce opioid consumption after sternotomy.
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