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Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery.
J Card Surg. 2020 Jul; 35(7):1525-1530.JC

Abstract

BACKGROUND

The optimum cardiac surgical pain management has known to maintain hemodynamic stability and, reduces respiratory and cardiovascular complications. Postoperative parasternal intercostal block has shown to reduce postoperative analgesic consumption after cardiac surgery. Therefore, this study sought to investigate the effectiveness of the preoperative ultrasound guided parasternal block in reducing postoperative pain after cardiac surgery.

METHODS

This was a randomized, prospective, interventional, single blind study comprised of 90 adult patients scheduled for cardiac surgery involving sternotomy. Preoperatively and postoperatively, 0.25% bupivacaine administered in 4 mL aliquots into the anterior (2nd-6th) intercostal spaces on each side about 2 cm lateral to the sternal edge with a total volume of 40 mL under ultrasound guidance and direct vision, respectively. Postoperative pain was rated according to visual analogue scale. Secondary outcomes included intraoperative and postoperative fentanyl consumptions, dosages of rescue medications, and time to extubation.

MAIN RESULTS

There was no significant differences in visual analogue score visual analogue score at all time points till 24 hours postoperatively. Intraoperative fentanyl requirements (microgram/kg) before cardiopulmonary bypass was significantly lower in pre-incisional group than the post-incisional group (0.16 ± 0.43 vs 0.68 ± 0.72; P = .0001). Furthermore, there were no significant difference in total fentanyl requirement (7.20 ± 2.66 vs 8.37 ± 3.13; P = .06) and tramadol requirement (0.02 ± 0.15 vs 0.07 ± 0.26; P = .28) within first 24 hours. However, time to extubation was significantly higher in the preoperative group (P = .02).

CONCLUSIONS

Preoperative and postoperative parasternal intercostal block provide comparable pain relief during the postoperative period.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32579779

Citation

Padala, Sri Rama Ananta Nagabhushanam, et al. "Comparison of Preincisional and Postincisional Parasternal Intercostal Block On Postoperative Pain in Cardiac Surgery." Journal of Cardiac Surgery, vol. 35, no. 7, 2020, pp. 1525-1530.
Padala SRAN, Badhe AS, Parida S, et al. Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. J Card Surg. 2020;35(7):1525-1530.
Padala, S. R. A. N., Badhe, A. S., Parida, S., & Jha, A. K. (2020). Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. Journal of Cardiac Surgery, 35(7), 1525-1530. https://doi.org/10.1111/jocs.14651
Padala SRAN, et al. Comparison of Preincisional and Postincisional Parasternal Intercostal Block On Postoperative Pain in Cardiac Surgery. J Card Surg. 2020;35(7):1525-1530. PubMed PMID: 32579779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of preincisional and postincisional parasternal intercostal block on postoperative pain in cardiac surgery. AU - Padala,Sri Rama Ananta Nagabhushanam, AU - Badhe,Ashok Shankar, AU - Parida,Satyen, AU - Jha,Ajay Kumar, Y1 - 2020/06/24/ PY - 2020/6/25/pubmed PY - 2020/6/25/medline PY - 2020/6/25/entrez KW - cardiac surgery KW - intercostal block KW - postoperative pain SP - 1525 EP - 1530 JF - Journal of cardiac surgery JO - J Card Surg VL - 35 IS - 7 N2 - BACKGROUND: The optimum cardiac surgical pain management has known to maintain hemodynamic stability and, reduces respiratory and cardiovascular complications. Postoperative parasternal intercostal block has shown to reduce postoperative analgesic consumption after cardiac surgery. Therefore, this study sought to investigate the effectiveness of the preoperative ultrasound guided parasternal block in reducing postoperative pain after cardiac surgery. METHODS: This was a randomized, prospective, interventional, single blind study comprised of 90 adult patients scheduled for cardiac surgery involving sternotomy. Preoperatively and postoperatively, 0.25% bupivacaine administered in 4 mL aliquots into the anterior (2nd-6th) intercostal spaces on each side about 2 cm lateral to the sternal edge with a total volume of 40 mL under ultrasound guidance and direct vision, respectively. Postoperative pain was rated according to visual analogue scale. Secondary outcomes included intraoperative and postoperative fentanyl consumptions, dosages of rescue medications, and time to extubation. MAIN RESULTS: There was no significant differences in visual analogue score visual analogue score at all time points till 24 hours postoperatively. Intraoperative fentanyl requirements (microgram/kg) before cardiopulmonary bypass was significantly lower in pre-incisional group than the post-incisional group (0.16 ± 0.43 vs 0.68 ± 0.72; P = .0001). Furthermore, there were no significant difference in total fentanyl requirement (7.20 ± 2.66 vs 8.37 ± 3.13; P = .06) and tramadol requirement (0.02 ± 0.15 vs 0.07 ± 0.26; P = .28) within first 24 hours. However, time to extubation was significantly higher in the preoperative group (P = .02). CONCLUSIONS: Preoperative and postoperative parasternal intercostal block provide comparable pain relief during the postoperative period. SN - 1540-8191 UR - https://www.unboundmedicine.com/medline/citation/32579779/Comparison_of_preincisional_and_postincisional_parasternal_intercostal_block_on_postoperative_pain_in_cardiac_surgery L2 - https://doi.org/10.1111/jocs.14651 DB - PRIME DP - Unbound Medicine ER -
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