Objectives
Poor pain control after cardiac surgery can be associated with postoperative complications,
longer recovery, and development of chronic pain. The authors hypothesized that adding
liposomal bupivacaine (LB) to plain bupivacaine (PB) will provide better and long-lasting
analgesia when used for wound infiltration in median sternotomy.
Study Design
Prospective, randomized, and double-blinded clinical trial.
Setting
Single institution, tertiary care university hospital.
Participants
Adult patients who underwent elective cardiac surgery through median sternotomy.
Interventions
A single surgeon performed wound infiltration of LB plus PB or PB into the sternotomy
wound, chest, and mediastinal tube sites.
Measurements and Main Results
Patients were followed up for 72 hours for pain scores, opioid consumption, and adverse
events.
Sixty patients completed the study for analysis (LB group [n = 29], PB group [n = 31]).
Patient characteristics, procedural variables, and pain scores measured at specific
intervals from 4 hours until 72 hours postoperatively did not reveal any significant
differences between the groups. Mixed-model regression showed that the trend of mean
pain scores at movement in the LB group was significantly (p = 0.01) lower compared
with the PB group. Opioid consumption over 72 hours was not significantly different
between the 2 groups (oral morphine equivalents; median [interquartile range], 139
[73, 212] mg in LB v 105 [54, 188] mg in PB, p = 0.29). Recovery characteristics and adverse events were
comparable.
Conclusions
LB added to PB for sternotomy wound infiltration during elective cardiac surgery did
not significantly improve the quality of postoperative analgesia.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pain management after cardiac surgery: are we underestimating post sternotomy pain?.J Med Assoc Thai. 2013; 96: 824-828
- Analgesia and sedation post-coronary artery bypass graft surgery: A review of the literature.Ther Clin Risk Manag. 2019; 15: 773-781
- Novel approaches in pain management in cardiac surgery.Curr Opin Anaesthesiol. 2015; 28: 89-94
- Impact of duration of chest tube drainage on pain after cardiac surgery.Eur J Cardiothorac Surg. 2000; 18: 570-574
- Pain after sternotomy - review.Braz J Anesthesiol. 2016; 66: 395-401
- Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting.Crit Care Med. 1999; 27: 2218-2223
- Postoperative myocardial ischemia. Therapeutic trials using intensive analgesia following surgery. The Study of Perioperative Ischemia (SPI) Research Group.Anesthesiology. 1992; 76: 342-353
- Nonopioid analgesics in postoperative pain management after cardiac surgery.Semin Cardiothorac Vasc Anesth. 2021; 25: 280-288
- Regional analgesia for cardiac surgery. Part 2: Peripheral regional analgesia for cardiac surgery.Semin Cardiothorac Vasc Anesth. 2021; 25: 252-264
- Regional anesthesia considerations for cardiac surgery.Best Pract Res Clin Anaesthesiol. 2019; 33: 387-406
- Liposomal bupivacaine and clinical outcomes.Best Pract Res Clin Anaesthesiol. 2014; 28: 15-27
- Continuous local infiltration analgesia for pain control after total knee arthroplasty: A meta-analysis of randomized controlled trials.Medicine (Baltimore). 2015; 94: e2005
- The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: A systematic review and meta-analysis with trial sequential analysis.Reg Anesth Pain Med. 2021; 46: 490-498
- Perineural liposomal bupivacaine is not superior to nonliposomal bupivacaine for peripheral nerve block analgesia: A systematic review and meta-analysis.Anesthesiology. 2021; 134: 147-164
- Comparison of liposomal bupivacaine and conventional local anesthetic agents in regional anesthesia: A systematic review.Anesth Analg. 2021; 132: 1626-1634
- Ultrasound-guided pecto-intercostal fascial block for postoperative pain management in cardiac surgery: A prospective, randomized, placebo-controlled trial.J Cardiothorac Vasc Anesth. 2021; 35: 896-903
- Ultrasound-guided regional anesthesia-current strategies for enhanced recovery after cardiac surgery.Medicina (Kaunas). 2021; 57
- Improved pain control after cardiac surgery: Results of a randomized, double-blind, clinical trial.J Thorac Cardiovasc Surg. 2003; 126: 1271-1278
- Local infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.J Thorac Cardiovasc Surg. 2008; 135: 1348-1352
- Use of a continuous local anesthetic infusion for pain management after median sternotomy.Anesthesiology. 2003; 99: 918-923
- Liposomal bupivacaine infiltration after median sternotomy in pediatric cardiac surgery.J Cardiothorac Vasc Anesth. 2021; 35: 1715-1721
- Liposomal bupivacaine-based erector spinae block for cardiac surgery.J Cardiothorac Vasc Anesth. 2021; 35: 1555-1559
- Fifty percent reduction in narcotic use after minimally invasive cardiac surgery using liposomal bupivacaine.Innovations (Phila). 2019; 14: 512-518
- A randomized controlled trial of liposomal bupivacaine parasternal intercostal block for sternotomy.Ann Thorac Surg. 2019; 107: 128-134
- Remifentanil and perioperative glycaemic response in cardiac surgery: An open-label randomised trial.Br J Anaesth. 2020; 124: 684-692
Article info
Publication history
Published online: October 11, 2022
Footnotes
This investigator initiated clinical trial was funded by Pacira Pharmaceuticals (Grant number; 713034).
K. Subramaniam and C. M. Sciortino contributed equally and are joint first authors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.