Author: Simon ER, et al.
BMJ Journal Regional Anesthesia & Pain Medicine, Published online August 24, 2025. doi:10.1136/rapm-2025-106952
This prospective, randomized, double-blind controlled trial investigated whether bilateral superficial parasternal intercostal plane (SPIP) blocks with liposomal bupivacaine could reduce postoperative opioid consumption after cardiac surgery via median sternotomy. One hundred patients undergoing elective CABG or valve surgery were randomized to receive either SPIP blocks with bupivacaine plus liposomal bupivacaine or saline placebo prior to incision.
The primary outcome—total opioid use in the first 72 hours—showed no significant difference between groups (165 MME [IQR 103–284] vs 205 MME [IQR 145–282], p = 0.30). Secondary outcomes including pain scores, time to extubation, ICU and hospital length of stay, and opioid use at 90 days were also similar. No major adverse events were reported.
The findings suggest that single-injection SPIP blocks with liposomal bupivacaine are safe but do not provide a meaningful opioid-sparing effect in cardiac surgery. Future research should examine catheter-based approaches, multilevel injections, block timing, alternative local anesthetics, and methods to better address chest tube-related pain.
Key Takeaways
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No reduction in opioid use with SPIP blocks compared to placebo over 72 hours.
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Pain scores, extubation time, ICU and hospital LOS, and long-term opioid use were unaffected.
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The technique was safe with no serious adverse events.
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Catheter-based or alternative strategies may provide more benefit than single injections.
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Targeting chest tube-related pain remains a priority in optimizing sternotomy analgesia.
Thank you to BMJ Journal Regional Anesthesia & Pain Medicine for publishing this important trial on regional analgesia in cardiac surgery.