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.