Key result
Parasternal bupivacaine infusion linked to ~53% lower post-sternotomy pain scores and reduced opioid use.
Why the study?
Opioids are widely used at high doses for postoperative pain after median sternotomy despite significant side effects, prompting investigation into continuous local anesthetic infusion.
Does parasternal continuous local anesthetic infusion reduce postoperative pain and opioid use in patients undergoing CABG surgery with median sternotomy?
Cohort (n=215)
No
Does parasternal continuous local anesthetic infusion reduce postoperative pain and opioid use in patients undergoing CABG surgery with median sternotomy?
Parasternal continuous bupivacaine infusion is a simple and effective method that significantly reduces postoperative pain, opioid consumption, and hospital stay in patients undergoing CABG via median sternotomy.
May support parasternal bupivacaine infusion to reduce post-sternotomy opioid use; leaves open need for randomized confirmation before practice change.
Introduction Effective treatment of postoperative pain due to median sternotomy speeds up hemodynamic healing of patients. For this purpose, opioids with a wide range of side effects are widely used at high doses. The aim of this study is to investigate the effect of continuous local anesthetic (bupivacaine) infusion on opioid use on cardiac surgery patients undergoing median sternotomy. Methods A total of 215 patients undergoing isolated coronary artery bypass grafting surgery were included in the study; and 105 patients who underwent parasternal continuous local anesthetic infusion (0.5% bupivacaine at 4 mL/h, for 48h) were determined as local anesthesia group and other patients were as control group. The primary outcomes evaluated between the groups in the postoperative period were pain scores (VAS: Visual Analogic Score, PHHPS: Prince Henry Hospital Pain Score) and the number of opioids used. Secondary outcomes were mechanical ventilation time, intensive care unit and hospital stay duration, development of atrial fibrillation and atelectasis. Results Postoperative pain was found to be significantly lower in the local anesthesia group compared to the control group (VAS: 3 ± 1.9 vs 6.4 ± 1.8, p < 0.001; PHHPS: 0.9 ± 0.8 vs 1.62 ± 0.82, p < 0.001). As a result of this, opioid drug use was significantly lower in the local anesthesia group compared to the control group (0 (0 - 4) vs 1 (0 - 8), p < 0.001). Mechanical ventilation time, intensive care unit and hospital stay duration, and development of atelectasis were significantly lower in the local anesthesia group. In terms of the development of atrial fibrillation, no significant difference was found between the groups. Conclusion Parasternal continuous local anesthetic infusion reduces postoperative opioid use and speeds up hemodynamic healing by preventing possible side effects of opioids. It is a simple and effective method in the treatment of postoperative pain due to median sternotomy.
No takes yet. Share an insight, caveat, or question.
Pala et al. (2020) conducted a cohort in Postoperative pain after median sternotomy for coronary artery bypass grafting (CABG) (n=215). Parasternal continuous local anesthetic infusion (bupivacaine) vs. No infusion (control group) was evaluated on Visual Analog Scale (VAS) pain score at 12 hours postoperatively (p=<0.001). Parasternal continuous local anesthetic infusion with 0.5% bupivacaine significantly reduced postoperative pain scores (VAS 3.0 vs 6.4) and median opioid use compared to no infusion in patients undergoing median sternotomy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: