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EP250 Rectus sheath block added to parasternal block improves respiratory performance after median sternotomy with drainage positioning in cardiac surgery patients
  1. Alessandro Strumia,
  2. Domenico Sarubbi,
  3. Annalaura Di Pumpo,
  4. Giuseppe Pascarella,
  5. Fabio Costa,
  6. Stefano Rizzo,
  7. Mariapia Stifano and
  8. Felice Eugenio Agrò
  1. Anaesthesia, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy


Background and Aims Pain is usually severe after cardiac surgery and can limit respiratory function. Parasternal block is used to control this pain; anyway, the block effect is limited to the sternal region and do not cover upper abdominal quadrants, where pleural and mediastinal drainages are positioned. Rectus sheath block is an analgesic technique widely used in abdominal surgery.

Methods 5 patients underwent CABG through median sternotomy. With patients consent, we performed ultrasound guided bilateral parasternal block (ropivacaine 0,5% 40 ml + dexamethasone 2 mg) after induction and ultrasound guided bilateral rectus sheath block (ropivacaine 0,25% 20ml + dexamethasone 2mg) at the end of the surgery. Multimodal i.v. analgesia: ketorolac 90mg/24h and acetaminophen 1 gr 3/die. Data regarded: perioperative pulmonary performance evaluated with the TriFlo Inspiratory Exerciser® and expressed in balls moved up during inspiration, pain during incentive spirometry at extubation/after 12 hours (0-10 NRS scale), opiates consumption.

Results Patients moved up a median of 2 (2-3) balls before surgery and a median of 2 (1-2) balls at extubation. 2 patients completely recovered respiratory function after 12 hours. Pain during spirometry at extubation was a median of 4 (3,5-5,5). Maximum pain in the first 12 hours was a median of 4 (3,5-5,5). Morphine consumption in the first 12 hours was a mean of 1 + 0,9 mg. No pulmonary complications occurred.

Abstract EP250 Figure 1

Rectus sheath block execution and local anaesthetic spread

Abstract EP250 Figure 2

The TriFlo Inspiratory Exerciser®

  • regional Anaesthesia
  • cardiac surgery
  • fascial plane block
  • analgesia

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