Optimising superficial parasternal intercostal plane blockade after cardiac surgery: single injection first?

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Cardiac surgery. Intervention: Continuous superficial parasternal intercostal plane (SPIP) blockade vs. Single-injection SPIP blockade.

Q: What does this research mean for the field?

Superficial parasternal intercostal plane (SPIP) blockade significantly reduces 72-hour opioid consumption after median sternotomy, though the optimal choice between single-injection and continuous blockade remains uncertain. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Sachin Mehta; Ron Ree; Christopher Prabhakar; Terri Sun; Tim Ting Han Jen

doi:10.1016/j.lana.2026.101610

August 22, 2026The Lancet Regional Health - AmericasOpen Access

Optimising superficial parasternal intercostal plane blockade after cardiac surgery: single injection first?

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Key result

Continuous superficial parasternal intercostal plane (SPIP) blockade does not currently demonstrate clinically meaningful incremental improvements over single-injection blockade to justify its routine use in cardiac surgery.

Why the study?

Does continuous SPIP blockade improve outcomes compared to single-injection SPIP blockade in patients undergoing cardiac surgery?

Key Points

To evaluate the efficacy of superficial parasternal intercostal plane (SPIP) blockade after cardiac surgery and determine whether continuous infusion provides meaningful clinical benefits over a single injection.
Appraisal of a multicentre trial assessing superficial parasternal intercostal plane (SPIP) blockade versus sham blockade after median sternotomy.
Evidence synthesis of randomised trials comparing continuous catheter infusion with single-injection ropivacaine blockade (N=80, N=58, and N=110) in cardiac and valve surgery.
Head-to-head trials showed mixed efficacy: one trial (N=58) reported a 48-h cumulative MME difference of −50·9 (95% CI −81·9 to −20·0; p = 0·002) favoring intermittent bolus over single injection, whereas another (N=80) found no difference in 24-h sternal pain on coughing (adjusted difference: −0·2, 95% CI −1·7 to 1·3; p = 0·79).
Continuous infusion trials raised safety concerns, reporting one suspected local anaesthetic systemic toxicity and one case of elevated plasma ropivacaine concentration above safe limits at 48 h.

Structured PICO

Does continuous SPIP blockade improve outcomes compared to single-injection SPIP blockade in patients undergoing cardiac surgery?

P

Population

Patients undergoing median sternotomy for cardiac surgery

I

Intervention

Continuous superficial parasternal intercostal plane (SPIP) blockade

C

Comparator

Single-injection SPIP blockade

Limitations

Differences in technique across existing trials
Scarce head-to-head data comparing continuous versus single-injection blockade
Risk of local anaesthetic systemic toxicity (LAST) with continuous infusion
Scarce head-to-head data
Risk of local anaesthetic systemic toxicity (LAST)

Ask about this paper

Answers are grounded in this paper and cite their sources.

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

AA Ahmad AlliAnesthesiologist, St Michael's Hospital, Toronto

“EPOCH CardioLink-10 was designed to determine whether a pragmatic, catheter-based SPIP regimen reduces postoperative opioid exposure versus placebo, not to isolate bolus versus catheter-dosing contributions, nor establish superiority over single-injection technique. Our findings should not be interpreted as a direct continuous-versus-single-injection comparison; equally, that absence does not support a preference for single-injection blockade.”

St Michael's Hospital–Unity Health TorontoEditorial

DMDavid MazerAnesthesiologist and scientist, St Michael's Hospital

“Modern-day cardiac surgery was originally made possible with the use of high-dose morphine-based anesthesia that provided stable heart function and blood pressure and allowed surgeons to do the kinds of surgery they needed to do.”

St Michael's Hospital–Unity Health TorontoNews Coverage

Implication

Single-injection SPIP blockade should remain the preferred technique for median sternotomy until continuous blockade shows clear patient-centered benefits that outweigh the risks.

Abstract

We congratulate Alli et al. on their multicentre trial, demonstrating that superficial parasternal intercostal plane (SPIP) blockade, compared with sham blockade, significantly reduced 72-h opioid consumption after median sternotomy.1 These findings reinforce prior literature supporting SPIP blockade in cardiac surgery,2 and we agree SPIP blockade should be incorporated into enhanced recovery after cardiac surgery pathways. However, the optimal choice between single-injection and continuous blockade remains uncertain.

Discussion

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Cite This Study

Mehta et al. (2026) conducted a letter in Cardiac surgery. Continuous superficial parasternal intercostal plane (SPIP) blockade vs. Single-injection SPIP blockade was evaluated. Continuous superficial parasternal intercostal plane (SPIP) blockade does not currently demonstrate clinically meaningful incremental improvements over single-injection blockade to justify its routine use in cardiac surgery.

synapsesocial.com/papers/6a8c00b3bca056c88e6df839 https://doi.org/10.1016/j.lana.2026.101610

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Optimising superficial parasternal intercostal plane blockade after cardiac surgery: single injection first?

Key Points

Structured PICO

Limitations

Ask about this paper

Key expert perspectives

Implication

Abstract

Discussion

Cite This Study

Optimising superficial parasternal intercostal plane blockade after cardiac surgery: single injection first?

Key Points

Structured PICO

Limitations

Ask about this paper

Key expert perspectives

Implication

Abstract

Discussion

Cite This Study

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