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Rectus sheath block added to parasternal block may improve postoperative pain control and respiratory performance after cardiac surgery: a superiority single-blinded randomized controlled clinical trial
  1. Alessandro Strumia1,
  2. Giuseppe Pascarella1,
  3. Domenico Sarubbi1,
  4. Annalaura Di Pumpo1,
  5. Fabio Costa1,
  6. Maria Cristina Conti1,
  7. Stefano Rizzo1,
  8. Mariapia Stifano1,
  9. Lara Mortini1,
  10. Alessandra Cassibba2,
  11. Lorenzo Schiavoni1,
  12. Alessia Mattei1,
  13. Alessandro Ruggiero2,
  14. Felice E Agrò1,2,
  15. Massimiliano Carassiti1,2 and
  16. Rita Cataldo1,2
  1. 1Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
  2. 2Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy
  1. Correspondence to Dr Alessandro Strumia, Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, 00128, Italy; a.strumia{at}


Background The population undergoing cardiac surgery confronts challenges from uncontrolled post-sternotomy pain, with possible adverse effects on outcome. While the parasternal block can improve analgesia, its coverage may be insufficient to cover epigastric area. In this non-blinded randomized controlled study, we evaluated the analgesic and respiratory effect of adding a rectus sheath block to a parasternal block.

Methods 58 patients undergoing cardiac surgery via median sternotomy were randomly assigned to receive parasternal block with rectus sheath block (experimental) or parasternal block with epigastric exit sites of chest drains receiving surgical infiltration of local anesthetic (control). The primary outcome of this study was pain at rest at extubation. We also assessed pain scores at rest and during respiratory exercises, opiate consumption and respiratory performance during the first 24 hours after extubation.

Results The median (IQR) maximum pain scores (on a 0–10 Numeric Rate Scale (NRS)) at extubation were 4 (4, 4) in the rectus sheath group and 5 (4, 5) in the control group (difference 1, p value=0.03). Rectus sheath block reduced opioid utilization by 2 mg over 24 hours (IC 95% 0.0 to 2.0; p<0.01), reduced NRS scores at other time points, and improved respiratory performance at 6, 12, and 24 hours after extubation.

Conclusion The addition of a rectus sheath block with a parasternal block improves analgesia for cardiac surgery requiring chest drains emerging in the epigastric area.

Trial registration number NCT05764616.

  • Postoperative Pain
  • Pain Management
  • Nerve Block
  • Postoperative Complications

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Conceptualization: AS, GP, DS, FC. Data curation: AR, ADP, MS, SR. Formal analysis: MCC, AS, GP. Funding acquisition: MC, RC, FEA. Investigation: GP, AS, AR, LM, ADP, MC, DS, AM, AC. Methodology: LS, AS. Project administration: FEA, MC, RC, FC, DS. Resources: LM, AS, AC, AR, SR, MS. Software: AS, GP, AR. Supervision: FEA, MC, RC, LS, AM, LM. Validation: MC, MCC, FC. Visualization: AS, GP, AR, AC. Roles/writing—original draft: AS, GP. Writing—review and editing: AS, GP, FC, RC. Guarantor: AS. All authors have made substantial contributions to all of the following: (1) the conception and design of the study, acquisition of data, analysis, and interpretation of data, (2) drafting the article and revising it critically for important intellectual content, and (3) final approval of the version to be submitted. Guarantor: AS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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