Catheter-Based Regional Anesthetic Techniques for Comprehensive Pain Management and Early Mobilization After Cardiac Sternotomy: A Report of Two Cases.

Abstract

Post-sternotomy pain management following cardiac surgery remains challenging, with both sternal incision and drain site pain requiring effective control. As highlighted recently, regional anesthetic techniques targeting the anterior cutaneous branches of the thoracic intercostal nerves offer promising solutions for comprehensive pain control while reducing opioid requirements. We present two patients who underwent cardiac surgery via sternotomy, with post-operative pain managed using different catheter-based regional anesthetic techniques. The first patient received bilateral deep parasternal intercostal plane block (DPIPB) catheters, while the second received a combination of a superficial parasternal intercostal plane block (SPIPB) and rectointercostal fascial plane block (RIFPB) with catheter placement. Both techniques demonstrated efficacy in managing post-sternotomy pain in our patients. The scheduled intermittent 0.25% levobupivacaine boluses provided analgesia that coincided with the patients' early mobilization activities, potentially contributing to their rehabilitation progress. The first patient achieved good pain control with DPIPB catheters when combined with oral analgesics, while the second patient, who received SPIPB as a single-shot block and RIFPB with indwelling catheters, achieved comprehensive pain control without requiring supplemental medications. Both cases highlight the importance of addressing epigastric drain site pain, which often presents significant challenges in post-sternotomy pain management. These catheter-based techniques provide extended, adaptable analgesia during the critical early mobilization period after cardiac surgery, balancing effective pain control with safety considerations. Further research is needed to compare these different approaches systematically and identify optimal strategies for diverse cardiac surgical procedures.