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Efficacy of parasternal block to decrease intraoperative opioid use in coronary artery bypass surgery via sternotomy: a randomized controlled trial
  1. Sébastien Bloc1,2,
  2. Brieuc P Perot3,
  3. Hadrien Gibert1,
  4. Jean-Dominique Law Koune1,
  5. Yannick Burg1,
  6. Didier Leclerc1,
  7. Anne-Sophie Vuitton1,
  8. Christophe De La Jonquière1,
  9. Marine Luka3,
  10. Thierry Waldmann4,
  11. Nicolas Vistarini4,
  12. Stéphane Aubert4,
  13. Mickaël M Ménager3,
  14. Messaouda Merzoug2,
  15. Cécile Naudin2 and
  16. Pierre Squara2,5
  1. 1Anesthesiology Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
  2. 2Clinical Research Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
  3. 3Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Imagine Institute, INSERM UMR 1163, ATIP-Avenir Team, Université de Paris, Paris, France
  4. 4Cardiac Surgery Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
  5. 5Critical Care Medicine Department, CMC Ambroise Paré, Neuilly-sur-Seine, France
  1. Correspondence to Sébastien Bloc, Anesthesiology Department, CMC Ambroise Paré, Neuilly-sur-Seine 92200, France; sebebloc{at}gmail.com

Abstract

Objective This study aims to assess the effect of a preoperative parasternal plane block (PSB) on opioid consumption required to maintain hemodynamic stability during sternotomy for coronary artery bypass graft surgery.

Methods This double-blind, randomized, placebo-controlled trial prospectively enrolled 35 patients scheduled for coronary artery bypass graft surgery under general anesthesia with propofol and remifentanil. Patients were randomized to receive preoperative PSB using either ropivacaine (PSB group) or saline solution (placebo group) (1:1 ratio). The primary endpoint was the maximal effect-site concentration of remifentanil required to maintain heart rate and blood pressure within the recommended ranges during sternotomy.

Results Median maximum concentration of remifentanil necessary to maintain adequate hemodynamic status during sternotomy was significantly reduced in PSB group (4.2 (2.5–6.0) ng/mL) compared with placebo group (7.0 (5.2–8.0) ng/mL) (p=0.02). Mean maximum concentration of propofol used to control depth of anesthesia was also reduced (3.9±1.1 µg/mL vs 5.0±1.5 µg/mL, PSB vs placebo, respectively; p=0.02). This reduction in propofol consumption during sternotomy enabled a more adequate level of sedation to be maintained in patients (minimum patient state index was 11.7±8.7 in placebo group and 18.3±6.8 in PSB group; p=0.02). PSB reduced postoperative inflammatory response by limiting concentrations of proinflammatory cytokines IL-8, IL-18, IL-23, IL-33 and MCP-1 measured in the first 7-day after surgery (p<0.05).

Conclusions Preoperative PSB reduced the maximum concentrations of remifentanil and propofol required to maintain hemodynamic stability and depth of anesthesia during sternotomy.

Trial registration number NCT03734159.

Sébastien Bloc, M.D.1,2; Brieuc P. Pérot, Ph.D.3; Hadrien Gibert, M.D.1; Jean-Dominique Law Koune, M.D.1; Yannick Burg, M.D.1; Didier Leclerc, M.D.1; Anne-Sophie Vuitton, M.D.1; Christophe De La Jonquière, M.D.1; Marine Luka, L.S.3; Thierry Waldmann, M.D.4; Nicolas Vistarini, M.D.4; Stéphane Aubert, M.D.4; Mickaël M. Ménager, Ph.D.3; Messaouda Merzoug, Ph.D.2; Cécile Naudin, Ph.D.2; Pierre Squara, M.D.2,5

  • nerve block
  • regional anesthesia
  • ultrasonography
  • anesthesia
  • conduction

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. Data: deidentified participant data. Center: Clinical Research Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France. Contact : recherche@clinique-a-pare.fr.

https://doi.org/10.1136/rapm-2020-102207

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information. Data: deidentified participant data. Center: Clinical Research Department, CMC Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine, France. Contact : recherche@clinique-a-pare.fr.

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    Footnotes

    • Contributors Study design and planning: SB, MMM, CN and PS. Data collection: SB, BPP, HG, J-DLK, YB, DL, A-SV, CDLJ and ML. Data analysis: MMM, CN and PS. Manuscript preparation: SB, BPP, MMM, CN and PS. Manuscript revision: HG, J-DLK, YB, DL, A-SV, CDLJ, TW, NV, SA and MMM.

    • Funding Support was provided solely from institutional and/or departmental sources from the department of Clinical Research, CMC Ambroise Paré, Neuilly-sur-Seine, France. The Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases is supported by State funding from the Agence Nationale de la Recherche under “ Investissements d’avenir” program (ANR-10-IAHU-01), the ATIP-Avenir program and Brieuc P Perot was also supported by the 2019 young researcher grant from Sidaction.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.