Impact of superficial and deep parasternal blocks on recovery after cardiac surgery with sternotomy: a randomised controlled trial

Abstract

Background: Pain is common after cardiac surgery and can impair recovery. Regional anaesthesia has been proposed to limit pain, but its impact on recovery is unknown. This study compared the impact of superficial or deep parasternal intercostal plane blocks (SPIP or DPIP) in addition to standard care vs standard care alone on postoperative quality of recovery (QoR) after cardiac surgery with sternotomy.

Methods: In this single-centre, randomised, single-blind, controlled trial, adult patients undergoing cardiac surgery with sternotomy were randomly assigned to one of three groups (with a 1:1:1 allocation ratio): control group (standard care without regional anaesthesia), SPIP group, or DPIP group. The primary endpoint was QoR assessed using a French validated version of the Quality of Recovery-15 questionnaire at 24 h after surgery. Secondary outcomes included postoperative pain scores, analgesic consumption, ICU and hospital length of stay, and adverse events.

Results: Between July 1, 2022, and August 30, 2023, we randomised 254 patients (81.1% men, 65.5 [27-85] yr). The French validated version of the Quality of Recovery-15 scores did not significantly differ between any parasternal block group (SPIP or DPIP) and the standard care group (P=0.248). Postoperative pain and analgesic consumption were similar across groups, with low pain scores (median [interquartile range] 24-h numerical rating scale: 2.0 [3.0-0.0]). There were more pneumothoraces in the DPIP group (P=0.032). No significant differences were observed for other complications.

Conclusions: Regional anaesthesia by parasternal intercostal plane blocks after sternotomy did not improve QoR at 24 h compared with standard care.

Clinical trial registration: NCT05345639.

Keywords: QoR-15; cardiac surgery; deep parasternal intercostal plane block; postoperative pain; recovery; regional anaesthesia; sternotomy; superficial parasternal intercostal plane block.