Intermittent Bolus versus Continuous Infusion Erector Spinae Catheters for Median Sternotomy Incisions:A Randomized Controlled Trial.

OBJECTIVE

To compare the analgesic efficacy of programmed intermittent boluses (PIB) and continuous infusion via indwelling erector spinae plane (ESP) catheters following open heart surgery. It was hypothesized that the use of PIB would result in superior analgesia compared to continuous infusion of local anesthetics through ESP catheters after cardiac surgery.

DESIGN

An Institutional Review Board-approved parallel-group, prospective, randomized, double-blind trial.

SETTING

A large academic hospital in the midwestern United States.

PARTICIPANTS

Adults undergoing open heart surgery via midline sternotomy and scheduled ESP analgesia with bilateral indwelling catheters.

INTERVENTIONS: Continuous infusion versus PIB of ropivacaine 0.2% via an electronic infusion pump.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was postoperative opioid consumption in oral morphine milligram equivalents (OMME) through 72 hours. The secondary outcomes included postoperative pain intensity on a numerical rating scale, length of stay, quality of recovery (QoR-15), time to first bowel movement, and antiemetic use. A total of 240 participants were randomized at a 1:1 ratio to PIB or continuous infusion. The PIB group had an estimated 1.08-fold greater OMME than the continuous infusion group (95% confidence interval [CI], 0.90-1.31; p = 0.40). The mean difference was 4.1 OMME greater per day for the PIB group (95% CI, -5.6 to +13.8 mg; p = 0.41). There were no statistically significant differences in secondary outcomes between the 2 groups.

CONCLUSIONS

In adults undergoing open heart surgery, ESP catheter-based analgesia via PIB did not significantly reduce early postoperative opioid consumption compared to a continuous infusion method.