Authors: Jen et al.
The Daily Dose, IARS, Friday, May 8, 2026
Analgesic Efficacy of Continuous Superficial Parasternal Intercostal Plane Blockade in Patients Undergoing Cardiac Surgery with Median Sternotomy: A Randomized Controlled Trial
Key Points
Tim Ting Han Jen, MD, MHSc, FRCPC, received the Kosaka Top Clinical Research Abstract Award for research on superficial parasternal intercostal plane blockade after cardiac surgery.
The study evaluated whether continuous SPIP blockade was superior to single-injection SPIP blockade for acute sternal pain after cardiac surgery with median sternotomy.
Continuous SPIP blockade did not reduce sternal pain on coughing at 24 hours compared with single-injection SPIP blockade.
No meaningful benefits were seen in secondary outcomes, including pain trajectory, opioid use, postoperative nausea or vomiting, quality of recovery, or chronic sternal pain.
The findings do not support routine use of continuous SPIP blockade after cardiac surgery with full median sternotomy.
Summary
This IARS Daily Dose article featured Tim Ting Han Jen, MD, MHSc, FRCPC, recipient of the 2026 Kosaka Top Clinical Research Abstract Award. Dr. Jen is a clinical assistant professor and staff anesthesiologist at St. Paul’s Hospital at the University of British Columbia in Vancouver, Canada. His award-winning research focused on postoperative pain management after cardiac surgery using regional analgesia, specifically superficial parasternal intercostal plane blockade in patients undergoing median sternotomy.
The clinical problem addressed by the study is highly relevant. Poststernotomy pain can interfere with pulmonary rehabilitation, mobilization, sleep, and delirium prevention after cardiac surgery. Fascial plane blocks have been recommended to reduce acute poststernotomy pain, and SPIP blockade has been shown to be safe and effective. However, single-injection techniques may have limited duration, while severe sternal pain can persist for 2 or more days after surgery.
Because of that limitation, continuous SPIP blockade has theoretical appeal. A catheter-based continuous technique could potentially extend analgesia beyond the duration of a single injection. However, continuous techniques also introduce greater complexity, higher cost, and additional safety considerations. Dr. Jen’s study was designed to answer whether those additional burdens are justified by better pain control.
The trial compared continuous SPIP blockade with single-injection SPIP blockade in patients undergoing cardiac surgery with full median sternotomy. The primary question was whether continuous blockade reduced acute sternal pain on coughing at 24 hours. This time point was chosen because patients often still have significant pain at 24 hours, while also being expected to begin active recovery and rehabilitation.
The most important finding was that continuous SPIP blockade did not demonstrate superiority over single-injection SPIP blockade for reducing sternal pain on coughing at 24 hours. In addition, no clinical benefit was observed across secondary outcomes. These included overall pain trajectory, cumulative opioid consumption, postoperative nausea or vomiting, quality of recovery, and chronic sternal pain.
The study has practical importance because it provides objective evidence for clinicians and institutions deciding whether to adopt catheter-based regional analgesic techniques after cardiac surgery. According to Dr. Jen, the trial had several strengths, including quadruple blinding, a prespecified statistical analysis plan, and an infusion regimen and catheter type informed by prior literature. These features strengthen the reliability of the findings and make the results useful for guideline development and institutional decision-making.
The article also placed this research in the broader context of the opioid crisis and enhanced recovery after cardiac surgery. As anesthesia teams seek opioid-sparing strategies, regional anesthesia techniques are increasingly important. However, this study shows that more complex regional techniques do not always produce better clinical outcomes. The key issue is not whether a technique is theoretically attractive, but whether it provides measurable patient benefit that justifies its added complexity and risk.
Dr. Jen described receiving the Kosaka Best Abstract Award as a major honor, especially as an early-career clinician-researcher. He also emphasized the importance of collaboration and acknowledged funding from the Canadian Anesthesia Research Foundation through the Canadian Anesthesiologists’ Society’s Dr. James Beckstead Award, along with support from St. Paul’s Hospital, nursing, pharmacy, cardiac surgery, the Acute Pain Service, statisticians, and the anesthesia research team.
Future research from Dr. Jen’s group will focus on the safety of regional anesthesia in cardiac surgical patients, the relationship between regional anesthesia techniques and postoperative arrhythmias, and the lived experiences of patients with chronic poststernotomy pain. These next steps may help define which regional strategies are most valuable after cardiac surgery and which patients are most likely to benefit.
What You Should Know
This article is important because it challenges the assumption that continuous catheter-based regional analgesia is automatically better than a single-injection technique. In this randomized controlled trial, continuous SPIP blockade did not improve pain on coughing at 24 hours after cardiac surgery with median sternotomy and did not improve opioid use, recovery quality, nausea or vomiting, or chronic sternal pain.
For anesthesia providers, the practical message is that continuous SPIP blockade should not be adopted routinely simply because it extends the duration of local anesthetic delivery. If a more complex technique does not improve outcomes, then the added cost, workload, catheter management, and safety considerations may not be justified.
The study supports thoughtful, evidence-based use of regional anesthesia in cardiac surgery. Single-injection SPIP blockade may remain a reasonable approach, while routine continuous SPIP catheters should be questioned unless future studies identify a subgroup of patients who clearly benefit.
Thank you to IARS and The Daily Dose for allowing us to summarize and share this article.