Superficial parasternal intercostal plane block catheters enhance recovery after pediatric midline sternotomy
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Abstract
BACKGROUND: Moderate to severe pain after surgery has been linked to midline sternotomies, particularly in pediatric patients. Inadequate pain control following this procedure can increase the chances of complications such as hemodynamic instability, arrhythmias, and respiratory system dysfunction, which can lead to morbidity. Traditionally, opioids have been utilized to treat postoperative pain but are not ideal due to the current opioid epidemic and their detrimental side effects on patients such as respiratory depression. Recently, peripheral regional nerve blocks have emerged as a safe and effective option for adequate pain relief in pediatric cardiac surgery, reducing opioid consumption. This study aimed to analyze the analgesic efficacy of the superficial intercostal parasternal plane (SPIP) block in pediatric cardiac surgery and compare it to erector spinae plane (ESP) block and non-blocked controls.
METHODS: Through a retrospective chart review at Boston Children’s Hospital, twenty patients, aged between 3-30 years old, were selected that had received continuous SPIP blocks after elective midline sternotomy procedures and compared to two other groups (aged between 2-17 years old) predetermined from unpublished, internal data, one group having received continuous ESP block after the sternotomy and the other receiving no block. All patients received standard Enhanced Recovery After Surgery (ERAS) multimodal analgesia. Postoperative opioid consumption was recorded as the primary outcome at 24 hours and 48 hours after surgery. Pain scores (NRS and FLACC), operating room (OR) extubation occurrence, and other secondary outcomes were recorded within the 48-hour postoperative period.
RESULTS: Opioid consumption was significantly higher in the SPIP group than the other groups within the first 24 hours after surgery but was significantly lower in the 24-48 hours after surgery. Pain scores were insignificant across all periods following surgery. OR extubation was also significantly lower in the SPIP group than in the other groups.
CONCLUSION: Pain after sternotomy can cause detrimental effects for pediatric patients if not treated, but there is also caution in relying solely on opioids for pain management. In pediatric midline sternotomy, the SPIP block effectively lowers postoperative opioid consumption up to 48 hours after surgery. This block may be of clinical value for effective analgesia for pediatric cardiac surgery patients within context of ERAS multimodal analgesia.
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2024