{
  "abstract": "Background The population undergoing cardiac surgery confronts challenges from uncontrolled post-sternotomy pain, with possible adverse effects on outcome. While the parasternal block can improve analgesia, its coverage may be insufficient to cover epigastric area. In this non-blinded randomized controlled study, we evaluated the analgesic and respiratory effect of adding a rectus sheath block to a parasternal block.Methods 58 patients undergoing cardiac surgery via median sternotomy were randomly assigned to receive parasternal block with rectus sheath block (experimental) or parasternal block with epigastric exit sites of chest drains receiving surgical infiltration of local anesthetic (control). The primary outcome of this study was pain at rest at extubation. We also assessed pain scores at rest and during respiratory exercises, opiate consumption and respiratory performance during the first 24 hours after extubation.Results The median (IQR) maximum pain scores (on a 0–10 Numeric Rate Scale (NRS)) at extubation were 4 (4, 4) in the rectus sheath group and 5 (4, 5) in the control group (difference 1, p value=0.03). Rectus sheath block reduced opioid utilization by 2 mg over 24 hours (IC 95% 0.0 to 2.0; p<0.01), reduced NRS scores at other time points, and improved respiratory performance at 6, 12, and 24 hours after extubation.Conclusion The addition of a rectus sheath block with a parasternal block improves analgesia for cardiac surgery requiring chest drains emerging in the epigastric area.Trial registration number NCT05764616.",
  "authors": [
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Alessandro Strumia"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Giuseppe Pascarella"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Domenico Sarubbi"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Annalaura Di Pumpo"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Fabio Costa"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Maria Cristina Conti"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Stefano Rizzo"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Mariapia Stifano"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Lara Mortini"
    },
    {
      "affiliations": [
        "Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy"
      ],
      "name": "Alessandra Cassibba"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Lorenzo Schiavoni"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy"
      ],
      "name": "Alessia Mattei"
    },
    {
      "affiliations": [
        "Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy"
      ],
      "name": "Alessandro Ruggiero"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy",
        "Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy"
      ],
      "name": "Felice E Agrò"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy",
        "Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy"
      ],
      "name": "Massimiliano Carassiti"
    },
    {
      "affiliations": [
        "Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy",
        "Research Unit of Anaesthesia and Intensive Care, Department of Medicine, Campus Bio-Medico University, Roma, Italy"
      ],
      "name": "Rita Cataldo"
    }
  ],
  "title": "Rectus sheath block added to parasternal block may improve postoperative pain control and respiratory performance after cardiac surgery: a superiority single-blinded randomized controlled clinical trial",
  "uid": "d6c1727d-510b-5de0-9b50-7f190ec232fa"
}