Parasternal Intercostal Block With Ropivacaine for Pain Management After Cardiac Surgery: A Double-Blind, Randomized, Controlled Trial

Objective: The purpose of this study was to test the hypothesis that administration of a parasternal intercostal block using ropivacaine 0.75% improved analgesia in postoperative cardiac surgical patients.Design: Randomized, controlled, double-blinded trial.Setting: Teaching hospital.Participants: Eighty-eight cardiac surgery patients.Interventions: Ropivacaine 0.75% with 5 doses each side, total dosage 40 mL (300 mg), via parasternal intercostal injection or saline before insertion of the sternal wires and closure of the sternal wound.Measurements and Main Results: At extubation, patients who had a parasternal intercostal block with ropivacaine had visual analog and numerical rating pain scores approximately 50% less than those in the saline group (29.5 [standard deviation (SD) = 24.3] v 53.2 [SD = 24.1], ropivacaine v saline, respectively, p < 0.001). Patients who received ropivacaine used approximately 50% less PCA morphine (12.0 [SD = 5.4] v 23.2 [SD = 8.3] total morphine equivalents in milligrams, ropivacaine v saline, respectively; p < 0.001) in the first 12 hours postoperatively, with a continued reduction in dosages for the ensuing 12 to 24 hours (18.8 [SD = 9.6] v 23.7 [SD = 10.0] total morphine equivalents in milligrams, ropivacaine v saline; p = 0.028).Conclusions: A ropivacaine parasternal intercostal block is a safe, simple, and effective adjunct for optimizing of pain control and reducing opioid analgesics after adult cardiac surgery. This study provides clinicians with an effective treatment for sternal wound pain.