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. 2023 Feb 16:16:11-18.
doi: 10.2147/LRA.S387631. eCollection 2023.

Addition of Deep Parasternal Plane Block to Enhanced Recovery Protocol for Pediatric Cardiac Surgery

Shelley Ohliger  1 , Alain Harb  1 , Caroline Al-Haddadin  1 , David P Bennett  1 , Tiffany Frazee  1 , Cassandra Hoffmann  1
Affiliations

Addition of Deep Parasternal Plane Block to Enhanced Recovery Protocol for Pediatric Cardiac Surgery

Shelley Ohliger et al. Local Reg Anesth. .

Abstract

Purpose: This study aims to evaluate if the addition of deep parasternal plane blocks to a pre-existing enhanced recovery pathway for pediatric cardiac surgery improves outcomes.

Patients and methods: A retrospective review through an EMR query from June 2019 to June 2021 was performed for patients less than 18 years of age who underwent cardiac surgery via median sternotomy and were extubated immediately following surgery in a single academic tertiary care hospital. Patients receiving deep parasternal blocks as part of an enhanced recovery protocol were compared to similar patients from the year prior to block implementation.

Results: The primary outcome was intraoperative and postoperative opioid consumption. Secondary outcomes were pain scores, intensive care unit (ICU) length of stay and time to first oral intake. There was a statistically significant reduction in intraoperative opioid administration and pain scores in the first 24 hours post-operatively. There was also a statistically significant reduction in ICU length of stay. There was no statistically significant difference in post-operative opioid consumption and time to first oral intake.

Conclusion: Bilateral deep parasternal blocks may reduce opioid consumption, provide effective postoperative pain control, and result in decreased length of intensive care unit stay across both simple and complex pediatric cardiac procedures when added to a pre-existing enhanced recovery protocol.

Keywords: congenital heart disease; enhanced recovery after surgery; pediatric cardiac surgery; regional anesthesia; truncal blocks.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Deep parasternal nerve block anatomy visualized with high-frequency linear probe prior to injection, showing respectively the pectoralis muscle (PM), intercostal muscle (IM), transversus thoracic plane (TTP), and transversus thoracic muscle (TTM).
Figure 3
Figure 3
Injectate placed superficial to the transversus thoracic muscle (TTM) in the transversus thoracic plane (TTP), with the needle under direct guidance passing through the pectoralis muscle (PM) and intercostal muscle (IM).
See this image and copyright information in PMC

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