Effect of Bilateral Ultrasound-Guided Deep Parasternal Intercostal Plane Block Before Extubation on Early Recovery After Cardiac Surgery via Median Sternotomy: A Randomized Controlled Trial.

introductionPostoperative pain remains a major concern after cardiac surgery via median sternotomy and may impair early recovery. Deep parasternal intercostal plane (DPIP) block is a regional analgesic technique targeting the parasternal intercostal nerves, but the effect of DPIP block performed before extubation on postoperative recovery has not been well defined. We therefore evaluated whether bilateral ultrasound-guided DPIP block administered before extubation could improve early recovery after median sternotomy cardiac surgery.

methodsIn this single-center, prospective, randomized, single-blind, controlled trial, 64 adults undergoing elective cardiac surgery via median sternotomy were randomly assigned in a 1:1 ratio to receive either a bilateral ultrasound-guided DPIP block with 0.375% ropivacaine or a saline placebo nerve block (control group) before extubation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h after extubation. Secondary outcomes included the QoR-15 score at 48 h after extubation, cumulative sufentanil consumption during the first 24 h after extubation, rescue analgesia requirement, time to first ambulation, and postoperative adverse events.

resultsOf the 64 randomized patients, 61 were included in the final analysis (30 in the DPIP group and 31 in the control group). Total QoR-15 scores were higher in the DPIP group than in the control group at both 24 h (112.83 ± 13.13 vs. 101.83 ± 13.50; P = 0.002) and 48 h (127.93 ± 9.65 vs. 121.53 ± 8.83; P = 0.01) after extubation. Cumulative sufentanil consumption during the first 24 h after extubation was lower in the DPIP group (50.00 [21.26-57.60] μg vs. 60.10 [48.00-63.40] μg; P = 0.016), and postoperative nausea and vomiting occurred less frequently (13.3% vs. 38.7%; P = 0.024). No significant between-group differences were observed in rescue analgesia requirement or time to first ambulation.

conclusionBilateral ultrasound-guided DPIP block performed before extubation was associated with improved early recovery after median sternotomy cardiac surgery, reflected by higher QoR-15 score, lower postoperative sufentanil consumption, and less postoperative nausea and vomiting. These findings suggest that the timing of DPIP block administration may be important in optimizing recovery after cardiac surgery. Future multicenter studies or studies with extended follow-up may be conducted to validate the generalizability of these findings.

trial registrationChinese Clinical Trial Registry, ChiCTR2400092616.