Multimodal analgesia with parasternal plane block protocol within an enhanced recovery after cardiac surgery program decreases opioid useCentral MessagePerspective
Marc Darras, MD,
Clément Schneider, MD,
Sandrine Marguerite, MD,
Saadé Saadé, MD,
Anne-Lise Maechel, MD,
Walid Oulehri, MD,
Olivier Collange, MD, PhD,
Jean-Philippe Mazzucotelli, MD, PhD,
Paul-Michel Mertes, MD, PhD,
Michel Kindo, MD, PhD
Affiliations
Marc Darras, MD
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Clément Schneider, MD
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Sandrine Marguerite, MD
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Saadé Saadé, MD
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Anne-Lise Maechel, MD
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Walid Oulehri, MD
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Olivier Collange, MD, PhD
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Jean-Philippe Mazzucotelli, MD, PhD
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Paul-Michel Mertes, MD, PhD
Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
Michel Kindo, MD, PhD
Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France; Address for reprints: Michel Kindo, MD, PhD, Service de Chirurgie Cardio-Vasculaire, Transplantation et Assistance Cardiaques – NHC, 1 place de l’Hôpital, 67091 Strasbourg Cedex, France.
Objective: This study investigated the efficacy of a multimodal analgesia (MMA) with an opioid-sparing strategy, incorporating a parasternal plane block (PPB) within a systematic standardized Enhanced Recovery After Surgery (ERAS) program for patients undergoing elective cardiac surgery. Methods: From 2015 to 2021, 3153 patients underwent elective coronary artery bypass grafting and/or valve procedures. Patients were dichotomized by the presence or absence of an ERAS program including a perioperative MMA with an opioid-sparing approach and PPB protocols. Propensity score matching yielded 1026 well-matched pairs. The primary outcomes were the opioid-free rate and the opioid consumption in morphine milligram equivalents (MME) in the intensive care unit (ICU). The secondary outcomes were postoperative visual analog scale (VAS) scores, mechanical ventilation duration, ileus, delirium, bronchopneumonia, and length of ICU stay. Results: The ICU opioid-free rate was significantly increased in the ERAS group (94.0%) compared with the control group (19.9%; P < .001). The ERAS group had significantly lower opioid consumption in the ICU compared with the control group (median; 11.0 MME vs 31.0 MME; P < .001; respectively). The VAS scores were analogous between the control and ERAS groups during the ICU stay. In the ERAS group, mechanical ventilation duration, ileus, delirium, bronchopneumonia rates, as well as length of ICU stay, were significantly reduced (both P < .05). Conclusions: Within a systematic, standardized ERAS program, MMA with an opioid-sparing strategy and PPB enables opioid-free analgesia in the majority of patients, significantly decreases opioid consumption, and ensures effective postoperative pain management, thereby improving outcomes.
