Multimodal analgesia with parasternal plane block protocol within an enhanced recovery after cardiac surgery program decreases opioid use

Objective

This study investigated the efficacy of a multimodal analgesia (MMA) with an opioid-sparing strategy, incorporating a parasternal plane block (PPB) within a systematic standardized Enhanced Recovery After Surgery (ERAS) program for patients undergoing elective cardiac surgery.

Methods

From 2015 to 2021, 3153 patients underwent elective coronary artery bypass grafting and/or valve procedures. Patients were dichotomized by the presence or absence of an ERAS program including a perioperative MMA with an opioid-sparing approach and PPB protocols. Propensity score matching yielded 1026 well-matched pairs. The primary outcomes were the opioid-free rate and the opioid consumption in morphine milligram equivalents (MME) in the intensive care unit (ICU). The secondary outcomes were postoperative visual analog scale (VAS) scores, mechanical ventilation duration, ileus, delirium, bronchopneumonia, and length of ICU stay.

Results

The ICU opioid-free rate was significantly increased in the ERAS group (94.0%) compared with the control group (19.9%; P < .001). The ERAS group had significantly lower opioid consumption in the ICU compared with the control group (median; 11.0 MME vs 31.0 MME; P < .001; respectively). The VAS scores were analogous between the control and ERAS groups during the ICU stay. In the ERAS group, mechanical ventilation duration, ileus, delirium, bronchopneumonia rates, as well as length of ICU stay, were significantly reduced (both P < .05).

Conclusions

Within a systematic, standardized ERAS program, MMA with an opioid-sparing strategy and PPB enables opioid-free analgesia in the majority of patients, significantly decreases opioid consumption, and ensures effective postoperative pain management, thereby improving outcomes.