Continuous serratus anterior block for sternotomy analgesia after cardiac surgery: a single-centre feasibility study.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2025-01-24 DOI:10.1016/j.bja.2024.11.042

Jonathan G Bailey, Ayman Hendy, Victor Neira, Edgar Chedrawy, Vishal Uppal

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引用次数: 0

Abstract

Background: Moderate-to-severe pain is common after cardiac surgery, peaking during the first and second postoperative days. Several nerve blocks for sternotomy have been described; however, the optimal location for continuous catheters has not been established. This study assessed the feasibility of a larger trial evaluating the efficacy of serratus anterior plane (SAP) catheter analgesia for sternotomy pain.

Methods: This double-blinded trial included patients undergoing cardiac surgery via sternotomy. Bilateral SAP catheters were placed in all participants, and randomised to ropivacaine or placebo. We assessed feasibility based on predetermined endpoints: (1) average recruitment rate >4 per month; (2) protocol adherence rate >90%; (3) primary outcome measurement rate >90%; and (4) significant catheter-related adverse event rate ≤2%. The quality of recovery index (QoR-15) was compared using an independent t-test.

Results: Of 52 participants randomised, feasibility data were available for 50. A definitive study was deemed 'not feasible' in our standalone centre owing to a low recruitment rate (2.4 per month) and a high adverse event rate (pneumothorax rate 12%). There were no major protocol deviations but minor deviations in 12% of participants. Pain, opioid consumption, complications, and quality of recovery were not different between groups. Long-term pain at 3 months was low in both groups.

Conclusions: A single-centre trial was deemed not feasible for our setting. With limited data, the quality of recovery was not different with ropivacaine dosing of bilateral SAP catheters for sternotomy pain.

Clinical trial registration: NCT04648774.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.