Better Healing After Heart Surgery: Presternal Catheter provides Advantage, study suggests

The Challenge of Post-Sternotomy Pain

Managing post-sternotomy pain is a critical concern for adults undergoing cardiac surgery. Severe pain after a median sternotomy can hinder breathing, delay mobility, and increase the risk of complications such as atelectasis and prolonged hospital stays. Traditional opioid-based pain relief, while effective, often brings unwanted side effects like respiratory depression and nausea, prompting the need for safer, more effective alternatives.

Study Design: Comparing Analgesic Techniques

Researchers at the All India Institute of Medical Sciences conducted a prospective, randomized, controlled study to evaluate the efficacy and safety of ropivacaine infiltration via a presternal multi-orifice catheter. The study enrolled 175 adults scheduled for elective cardiac surgery via median sternotomy, randomized into three groups:

• Group A: Continuous infusion of 0.375% ropivacaine via presternal catheter.

• Group B: Intermittent bolus of 0.375% ropivacaine every 8 hours via the same catheter.

• Group C: Conventional intravenous tramadol (control).

Pain was assessed for 48 hours post-extubation using the Visual Analogue Scale (VAS). Cumulative tramadol requirements and secondary outcomes like extubation time, ICU stay, and infection rates were recorded.

Major Findings: Intermittent Bolus Outshines Continuous Infusion

1. Superior Pain Control:

Group B (intermittent bolus) consistently reported the lowest VAS pain scores, both at rest and during coughing, at all measured time points compared to the continuous infusion and control groups.

2. Reduced Opioid Need:

Patients in Group B required significantly less rescue tramadol (56 ± 35mg) over 48 hours than those in Group A (155 ± 32mg) or Group C (135 ± 45mg), highlighting a marked reduction in opioid consumption.

3. Safety Profile:

There were no significant differences among the groups regarding hemodynamic stability, time to extubation, ICU length of stay, or wound infection. No adverse catheter-related events or local anesthetic toxicity were observed, underscoring the safety of the approach.

4. Technique Simplicity and Applicability:

Presternal catheter placement is straightforward, avoiding the complexities and risks associated with regional or neuraxial blocks—especially relevant for patients on anticoagulants. The technique did not require special skills or ultrasound guidance.

Clinical Implications and Limitations

The study’s results favor intermittent bolus administration of ropivacaine for post-sternotomy analgesia. This method offers enhanced pain relief and opioid-sparing benefits without increasing complication risks. However, the analgesic effect was limited to the sternotomy site and did not address other sources of pain related to cardiac surgery (e.g., graft harvest or drain sites). Future studies are warranted to optimize dosing and assess broader functional outcomes.

Citation:

Swetha LS, Prakash M, Hasija S, Gayatri BS, Chauhan S, Jha PK. Efficacy of ropivacaine infiltration by presternal multi-orifice catheter for post-sternotomy pain relief in adult patients undergoing cardiac surgery—A prospective, randomized, control study. Annals of Cardiac Anaesthesia. 2026;29:104-9.