A Retrospective Review of the Deep Parasternal Intercostal Plane Block in Patients Undergoing Cardiac Surgery with Median Sternotomy.

Abstract

Background/Objectives: Regional anesthesia is an important part of Enhanced Recovery after Cardiac Surgery (ERACS) protocols designed to enhance analgesia, reduce opioid use, and improve postoperative outcomes. The deep parasternal intercostal plane (Deep-PIP) block is a fascial plane block in which local anesthetics are injected between the intercostal and transversus thoracis muscles to block neural transmission through the anterior cutaneous branches of the intercostal nerve. This study evaluates the impact of the Deep-PIP block in patients undergoing cardiac surgery via median sternotomy. Methods: In this retrospective cohort study, patients were divided into cohorts of 232 patients who had a block (BLOCK group) and 351 patients who did not receive a block (NOBlock group) using propensity score matching. Pain scores and opioid consumption over 24 h, extubation times, and ICU and hospital length of stay were compared for the two groups. Several subgroup analyses were also performed to evaluate the effects of block technique and block adjuvants. Results: While there was not a statistically significant difference in opioid consumption between the two groups, the BLOCK group had significantly lower pain scores, extubation times, and hospital length of stay. The subgroup analyses showed that modifications to block technique and use of block adjuvants were associated with reduced opioid consumption, but did not significantly affect pain scores, extubation time, or ICU or hospital length of stay. Conclusions: This study demonstrates the benefits of the deep parasternal intercostal plane block as part of an ERACS protocol. Routine implementation of the Deep-PIP block is reasonable given its potential benefits combined with its positive safety profile.