A Sufficiently Effective and Low-Risk Plane Block: A Randomized Controlled Trial Evaluating the Modified Parasternal Block in Off-Pump Coronary Artery Bypass Grafting with Sternotomy
In brief
Modified parasternal block halves intraoperative opioid use in off-pump CABG
In a randomized trial of 65 patients, the block cut sufentanil use from about 280 µg to 130 µg and lowered inflammatory markers. Patients also reported less pain, recovered gut function sooner, spent less time on the ventilator, had fewer lung complications and left the hospital earlier, with plasma ropivacaine levels remaining well below toxicity thresholds.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 21 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Xiaoxian Feng, Rongtian Kang, Lining Huang, Fang Yan, Dongqi Yao, Xuze Li
- PMID
- 42652874
- DOI
- 10.3390/jcm15166472
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 30 August 2026): RCT of modified parasternal block in cardiac surgery
Abstract
Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0-167.5] μg vs. 280.0 [IQR, 192.5-327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.