INTRODUCTION
Effective postoperative pain management is a cornerstone of recovery after cardiac surgery, particularly in off-pump coronary artery bypass (OPCAB) procedures where median sternotomy often results in significant sternal pain. This discomfort can delay recovery, extend ICU stays, and may lead to chronic postoperative sternal pain syndrome. The implementation of ultrasound-guided regional blocks has gained traction as part of Enhanced Recovery After Cardiac Surgery (ERACS) protocols. Among these, the parasternal intercostal plane block (PIPB) has shown promise in mitigating postoperative pain. This single-center retrospective cohort study evaluates the clinical efficacy of a deep, single-shot PIPB in managing acute postoperative pain among 157 OPCAB patients. By comparing those who received the block (38 patients) to a standard therapy group (119 patients), and applying propensity score matching, the study provides insight into pain outcomes, analgesic usage, extubation times, and ICU metrics. The findings offer critical evidence for incorporating PIPB into multimodal analgesic strategies.
ANALGESIC OUTCOMES AND OPIOID SPARING EFFECTS
One of the central objectives of the study was to evaluate whether deep parasternal intercostal plane blocks (PIPB) could reduce the need for opioid analgesics. Patients who received PIPB demonstrated a significantly lower requirement for piritramide at both 24 and 48 hours postoperatively. Furthermore, the total morphine equivalent (ME) requirement was considerably reduced in the PIPB group. These opioid-sparing effects are clinically relevant, particularly in light of ongoing concerns about opioid overuse and associated complications. The results confirm the potential of PIPB as a non-opioid alternative that can enhance patient safety and reduce pharmacological burden during the early recovery phase.
EVALUATION OF PAIN PERCEPTION THROUGH BPS AND NRS SCORES
Accurate assessment of patient pain perception was integral to this study’s methodology. Behavioral Pain Scores (BPS) and Numeric Rating Scores (NRS) were used to measure postoperative pain levels up to 48 hours after extubation. Results indicated that patients who received the deep PIPB reported significantly lower NRS values. These subjective pain scores further validated the block’s analgesic effectiveness. Although BPS scores were not explicitly detailed in the summary, the overall trend suggested that patients had improved comfort, leading to faster recovery and reduced reliance on emergency analgesia. This highlights the relevance of integrating both objective and subjective tools in postoperative pain evaluation.
TIME TO EXTUBATION AND EARLY RECOVERY METRICS
An encouraging finding of the study was the reduction in time to extubation among patients who underwent the PIPB procedure. Faster extubation is a critical parameter within ERACS protocols and often correlates with better pain control and overall physiological stability. The PIPB group exhibited improved readiness for weaning from mechanical ventilation, likely due to reduced opioid-induced respiratory depression and enhanced analgesia. However, while extubation times were positively affected, the study did not find significant differences in ICU length of stay. This suggests that while PIPB influences immediate postoperative recovery, additional variables impact longer-term ICU outcomes.
PROPENSITY SCORE MATCHING FOR VALIDATION
To reinforce the reliability of the study findings, a one-to-one propensity score matching analysis was performed. This statistical technique minimizes selection bias by aligning patient characteristics between the PIPB and non-PIPB groups, ensuring that observed differences in outcomes are more likely due to the intervention rather than confounding factors. Post-matching analysis reaffirmed the primary results: patients in the PIPB group required fewer intravenous analgesics and experienced improved early recovery outcomes. This strengthens the internal validity of the study and supports the adoption of PIPB in standardized perioperative care protocols for cardiac surgery.
LIMITATIONS AND FUTURE RESEARCH DIRECTIONS
While the study presents robust evidence supporting deep PIPB in OPCAB surgeries, it is not without limitations. Being a retrospective, single-center analysis, it is subject to inherent biases despite propensity score matching. Moreover, some outcomes like ICU stay, incidence of nausea, and vomiting did not differ significantly, suggesting a need for larger, multicenter randomized controlled trials to further validate findings. Future research could also explore the benefits of continuous versus single-shot PIPB, long-term pain outcomes, and quality-of-life metrics to better understand the full impact of this technique in cardiac surgical care.
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