Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

Devishree Das; Sandeep Chauhan; Sushama Gayatri; Minati Chaudhury; Neeti Makhija; Akshay K Bisoi

doi:10.1053/j.jvca.2023.07.007

Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study

J Cardiothorac Vasc Anesth. 2023 Nov;37(11):2282-2288. doi: 10.1053/j.jvca.2023.07.007. Epub 2023 Jul 10.

Authors

Devishree Das¹, Sandeep Chauhan², Sushama Gayatri³, Minati Chaudhury², Neeti Makhija², Akshay K Bisoi³

Affiliations

¹ Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India. Electronic address: devishreedas111@gmail.com.
² Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India.
³ Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, AIIMS, New Delhi, India.

PMID: 37558558
DOI: 10.1053/j.jvca.2023.07.007

Abstract

Objective: To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery.

Design: A prospective, randomized, and double-blind comparative study.

Setting: At a single-institution tertiary referral cardiac center.

Participants: The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy.

Interventions: Children were allocated randomly to 1 of 3 groups. Group A (n = 65) and group B (n = 64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n = 64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively.

Measurements and main results: Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n = 60), B (n = 60), and C (n = 60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p = 0.07).

Conclusion: LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.

Keywords: cardiac surgery; incisional infiltration; local anesthesia; pediatric patient; post-sternotomy pain; presternal catheter.