Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial

Abstract

Objectives Cardiac surgery via full sternotomy impacts postoperative lung function. We studied whether ultrasound-guided superficial parasternal intercostal plane block (SPIP) before surgical aortic valve replacement via full sternotomy would ameliorate postoperative lung function and filtration capacity. Methods A total of 74 consecutive patients undergoing surgical aortic valve replacement were randomized to receive either or not additional SPIP. Pre- and postoperative lung function tests were compared among the patients. Venous and arterial blood samples were collected to calculate lung filtration (venous/arterial) of the inflammatory factors chemerin, chitinase-3-like protein 1 (YKL-40), resistin, and interleukin-6 (IL6) immediately before (T1), 1 hour after releasing aortic cross-clamp (T2), and on the following morning (T3) after surgery in 30 age- and sex-adjusted patients. Results Patients with SPIP were older as compared to those without (66.7 [10.7] vs 60.2 [13.4], years, respectively, P < 0.04). Neither other patient characteristics nor preoperative lung functions differed between the patient groups. Forced expiratory volume in 1 second (FEV), forced volume capacity (FVC), and relative FVC changes decreased less in patients treated with wound analgesia as compared to those without (P = 0.024, P = 0.042, and P = 0.042). Total oxycodone consumption (P = 0.634), YKL-40, and resistin did not differ between the groups. Arterial chemerin decreased and venous/arterial IL6 ratio increased in patients with SPIP as compared to those without (P = 0.024 versus P = 0.332, respectfully). Conclusions SPIP before aortic valve surgery via full sternotomy impacts postoperative respiratory function and venous/arterial IL6 ratio. Clinical registration number The study was approved by the institutional review board (Ethical Committee of the Tampere University Hospital, Tampere, Finland, registration number R18011M) on March 8, 2018, and the study conforms to the ethical guidelines of the Declaration of Helsinki.