ROLE OF REGIONAL ANESTHESIA IN PAIN MANAGEMENT IN STERNOTOMY PATIENTS UNDERGOING CARDIAC SURGERY

Abstract

Background: Sternotomy for cardiac surgery results in significant postoperative pain, which, if inadequately managed, can impair respiratory function, prolong recovery, and increase opioid consumption. Poor pain control leads to reduced inspiratory effort, atelectasis, decreased sputum clearance, and respiratory infections. Effective analgesia is essential for optimizing postoperative outcomes while minimizing opioid-related side effects. Regional anesthesia techniques, particularly parasternal intercostal blocks, have shown promise in improving pain relief, enhancing pulmonary function, and reducing opioid requirements, thereby improving patient recovery and overall surgical outcomes.

Objective: This study evaluates the effectiveness of parasternal intercostal blocks in postoperative pain management for sternotomy patients undergoing cardiac surgery, focusing on pain scores, opioid consumption, pulmonary function, and ICU stay duration.

Methods: A prospective study was conducted on 50 patients who underwent median sternotomy for elective cardiac surgery at Bahria International Hospital. Patients were divided into two groups: one receiving conventional opioid-based analgesia and the other receiving parasternal intercostal blocks with 0.25% ropivacaine (10 mL bilaterally at two levels). Pain scores were assessed using the Visual Analogue Scale (VAS) at 2, 6, 12, and 24 hours postoperatively. Opioid consumption, postoperative nausea and vomiting (PONV) incidence, pulmonary function tests, and ICU stay duration were analyzed. Statistical comparisons were performed using independent t-tests and chi-square tests, with a significance threshold of p < 0.05.

Results: The parasternal block group had significantly lower VAS pain scores at 2, 6, 12, and 24 hours (4.3 ± 1.0 vs. 7.5 ± 1.2, 3.9 ± 0.9 vs. 6.8 ± 1.5, 3.5 ± 0.8 vs. 6.0 ± 1.4, and 3.0 ± 0.6 vs. 5.2 ± 1.3, respectively; p < 0.05). Opioid consumption was reduced by 40%, with fentanyl requirements at 24 hours lower in the block group (30 ± 8 µg vs. 70 ± 14 µg; p < 0.05). The incidence of PONV was significantly lower (15% vs. 45%), and ICU stay was reduced in the block group (36 ± 4 hours vs. 48 ± 5 hours; p < 0.05). Pulmonary function parameters, including FEV1 (2.3 ± 0.4 L vs. 1.8 ± 0.3 L) and incentive spirometry capacity (2100 ± 300 mL vs. 1500 ± 250 mL), were significantly improved in the parasternal block group.

Conclusion: Parasternal intercostal blocks significantly improve postoperative analgesia, reduce opioid consumption, and enhance pulmonary function in sternotomy patients undergoing cardiac surgery. The reduction in ICU stays and opioid-related side effects underscores the clinical benefits of integrating this regional anesthesia technique into standard perioperative pain management protocols. Further large-scale studies are warranted to explore its long-term impact on patient outcomes.