Bilateral continuous thoracic paravertebral block versus IV fentanyl infusion for perioperative analgesia in patients undergoing cardiac surgery through median sternotomy

Background

In patients who are undergoing open cardiac surgery, thoracic paravertebral block (TPVB) is advantageous for pain management. Our objective was to compare this type of block with intravenous Fentanyl analgesia in those patients.

Methodology

This prospective, randomized study included 44 patients who underwent open-heart surgery through a median sternotomy. Participants were randomly divided into two equal groups (each with 22 subjects). Group I (Fentanyl group) (n = 22): received fentanyl infusion 2 µg/kg/h after placing the endotracheal tube and stopped at the end of surgery. Group II (TPVB group) (n = 22): Bilateral thoracic paravertebral catheters were inserted preoperative. Before induction, there was a maximum of 20 ml per side for each catheter, which received a bolus dose of 0.3 ml/kg 0.25% bupivacaine. Continuous infusion of 0.25% bupivacaine at a rate of 0.1 ml/kg/h was administered through each catheter following intubation. The infusion was subsequently discontinued at the conclusion of the procedure.

Results

Critical-Care Pain Observation Tool (CCPOT) was lower in patients of group II (TPVB group) than in patients of group I (fentanyl group); in group II at 8 h, 12 h, and 24 h postoperative were 2,3,3, respectively, whereas median CCPOT in group I at 8 h, 12 h, and 24 h postoperative were 3,4,4, respectively (p-value < 0.05). In comparison with group I, there was a substantial decrease in the intraoperative fentanyl requirements of group II (343.6 µg ± 44.1 and 926.8 µg ± 117.4) (p-value < 0.05). In comparison with group I (9 mg 2), the TPVB group’s postoperative opioid requirements were significantly lower (6.2 mg 2.3). P-value was less than 0.05.

Conclusion

Compared with IV fentanyl infusion, Bilateral continuous thoracic paravertebral block was determined to be more effective in the operative and postoperative analgesia of patients who underwent heart surgery via median sternotomy.