Can Continuous Local Anesthetic Infusion After Median Sternotomy Reduce Opioid Use?

Arda Aybars Pala, Yusuf Salim Urcun, Ömer Faruk Çiçek, Serpil Şahin, Arda Aybars Pala, Yusuf Salim Urcun, Ömer Faruk Çiçek, Serpil Şahin

Abstract

Introduction Effective treatment of postoperative pain due to median sternotomy speeds up hemodynamic healing of patients. For this purpose, opioids with a wide range of side effects are widely used at high doses. The aim of this study is to investigate the effect of continuous local anesthetic (bupivacaine) infusion on opioid use on cardiac surgery patients undergoing median sternotomy. Methods A total of 215 patients undergoing isolated coronary artery bypass grafting surgery were included in the study; and 105 patients who underwent parasternal continuous local anesthetic infusion (0.5% bupivacaine at 4 mL/h, for 48h) were determined as local anesthesia group and other patients were as control group. The primary outcomes evaluated between the groups in the postoperative period were pain scores (VAS: Visual Analogic Score, PHHPS: Prince Henry Hospital Pain Score) and the number of opioids used. Secondary outcomes were mechanical ventilation time, intensive care unit and hospital stay duration, development of atrial fibrillation and atelectasis. Results Postoperative pain was found to be significantly lower in the local anesthesia group compared to the control group (VAS: 3 ± 1.9 vs 6.4 ± 1.8, p < 0.001; PHHPS: 0.9 ± 0.8 vs 1.62 ± 0.82, p < 0.001). As a result of this, opioid drug use was significantly lower in the local anesthesia group compared to the control group (0 (0 - 4) vs 1 (0 - 8), p < 0.001). Mechanical ventilation time, intensive care unit and hospital stay duration, and development of atelectasis were significantly lower in the local anesthesia group. In terms of the development of atrial fibrillation, no significant difference was found between the groups. Conclusion Parasternal continuous local anesthetic infusion reduces postoperative opioid use and speeds up hemodynamic healing by preventing possible side effects of opioids. It is a simple and effective method in the treatment of postoperative pain due to median sternotomy.

Keywords: local anesthesia; median sternotomy; opioid; postoperative pain.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Pala et al.

Figures

Figure 1. Distribution of number of opioids…
Figure 1. Distribution of number of opioids used in the postoperative period between groups
Figure 2. Distribution of Visual Analogue Scale…
Figure 2. Distribution of Visual Analogue Scale scores between groups
Figure 3. Comparison of Prince Henry Hospital…
Figure 3. Comparison of Prince Henry Hospital Pain Score between groups

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