TOPLINE

Among patients who underwent cardiac surgery via median sternotomy, those who received a bilateral deep parasternal intercostal plane (DPIP) block had less resting pain at some timepoints after surgery but did not report better recovery at 24 hours than those who received standard care.

METHODOLOGY

• Researchers conducted a randomized single-blind superiority trial to assess whether a DPIP block improved the quality of recovery in adults who underwent cardiac surgery with cardiopulmonary bypass via median sternotomy.
• They enrolled 128 patients at a French center between 2022 and 2025 and included 126 in the final analysis. Patients were randomly assigned to receive standard care (control group; n = 63; mean age, 69.2 years; 87.3% men) or standard care plus a DPIP block (DPIP group; n = 63; mean age, 66.6 years; 74.6% men). 
• In the DPIP group, anesthesiologists used ultrasound to guide injection of 20 mL of ropivacaine 3.75 mg/mL per side after induction of anesthesia and before incision.
• Patients rated their recovery 24 hours after surgery on the 15-item Quality of Recovery (QoR-15) questionnaire, which served as the primary outcome. Scores ranged from 0 to 150, and higher scores indicated better recovery.
• Secondary outcomes included QoR-15 at day 5, pain scores up to 48 hours on a 0-10 scale, use of opioids, and complications.

TAKEAWAY

• At 24 hours, the mean QoR-15 score was 101.2 in the DPIP group vs 97.3 in the control group, with a nonsignificant difference of 3.9 points. On day 5, patients in the DPIP group scored higher than those in the control group (mean difference, 8.51 points; P = .041).
• Patients in the DPIP group reported lower resting pain than those in the control group at 2 hours (mean difference, -1.70), at 6 hours (mean difference, -0.79), and at 48 hours (mean difference, -0.85; P < .05 for all), but not at 12 or 24 hours or when coughing.
• Patients in the DPIP group required less remifentanil during surgery than those in the control group (mean difference, -212 µg; P = .014), although the use of morphine at 24 hours and 48 hours after surgery did not differ significantly between groups.
• In an exploratory post hoc analysis involving 71 patients who had an internal mammary artery harvested, QoR-15 scores at 24 hours were higher in the DPIP group than in the control group (P = .027). 
• Pneumothorax occurred in four patients in the DPIP group and two in the control group; one patient in the DPIP group had a hematoma. None of the differences were significant.

IN PRACTICE

"Although exploratory in nature, these findings raise the possibility that the effectiveness of DPIP block may vary according to the anatomical distribution of surgical trauma and its overlap with the dermatomal territory covered by the block," the researchers reported.

SOURCE

The study was led by Marc Lopez of Institut Arnault Tzanck in Saint-Laurent-du-Var, France. It was published online on October 15 in the Journal of Cardiothoracic and Vascular Anesthesia.

LIMITATIONS

The study was conducted at a single center, which may have limited external validity. The absence of a double-blind design may have introduced performance bias. The subgroup analysis of patients who had an internal mammary artery harvested had a relatively small sample size.

DISCLOSURES

The study received support from the APICIL Foundation. The authors did not declare any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.