Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial

Abstract

Objectives: Cardiac surgery via full sternotomy impacts postoperative lung function. We studied whether ultrasound-guided superficial parasternal intercostal plane block (SPIP) before surgical aortic valve replacement via full sternotomy would ameliorate postoperative lung function and filtration capacity.

Methods: A total of 74 consecutive patients undergoing surgical aortic valve replacement were randomized to receive either or not additional SPIP. Pre- and postoperative lung function tests were compared among the patients. Venous and arterial blood samples were collected to calculate lung filtration (venous/arterial) of the inflammatory factors chemerin, chitinase-3-like protein 1 (YKL-40), resistin, and interleukin-6 (IL6) immediately before (T1), 1 hour after releasing aortic cross-clamp (T2), and on the following morning (T3) after surgery in 30 age- and sex-adjusted patients.

Results: Patients with SPIP were older as compared to those without (66.7 [10.7] vs 60.2 [13.4], years, respectively, P < 0.04). Neither other patient characteristics nor preoperative lung functions differed between the patient groups. Forced expiratory volume in 1 second (FEV), forced volume capacity (FVC), and relative FVC changes decreased less in patients treated with wound analgesia as compared to those without (P = 0.024, P = 0.042, and P = 0.042). Total oxycodone consumption (P = 0.634), YKL-40, and resistin did not differ between the groups. Arterial chemerin decreased and venous/arterial IL6 ratio increased in patients with SPIP as compared to those without (P = 0.024 versus P = 0.332, respectfully).

Conclusions: SPIP before aortic valve surgery via full sternotomy impacts postoperative respiratory function and venous/arterial IL6 ratio.

Clinical registration number: The study was approved by the institutional review board (Ethical Committee of the Tampere University Hospital, Tampere, Finland, registration number R18011M) on March 8, 2018, and the study conforms to the ethical guidelines of the Declaration of Helsinki. The trial was registered as ClinicalTrials.gov ID NCT03704753 (EudraCT = 2017-004744-38).

Keywords: SPIP; aortic valve replacement; interleukin-6; lung function.

Graphical abstract

Figure 1.

Calculated Ratio of the Venous Chemerin, YKL-40, Resistin, and Interleukin-6 (IL6) Divided By the Simultaneous Arterial Chemerin (A), YKL-40 (B), Resistin (C), and IL6 (D) Immediately Before Surgery (1), At Surgery (2), and Postoperatively the Day After Surgery (3) in Patients Undergoing Aortic Valve Replacement Via Full Sternotomy with SPIP (Blue Bars) and Without SPIP (Red Bars). Horizontal lines of the box show the median. Lines above and below the box indicate the 75th and 25th percentiles, respectively. Note increased venous/artery IL6 ratio > 1 in patients with SPIP at T3 versus T1, indicating excessive filtration of proinflammatory IL6 (D). *P = 0.024. YKL-40: chitinase-3-like protein 1.